Duct stenting versus modified Blalock-Taussig shunt in neonates and infants with duct-dependent pulmonary blood flow: A systematic review and meta-analysis.

Published on Feb 1, 2021in The Journal of Thoracic and Cardiovascular Surgery4.451
· DOI :10.1016/J.JTCVS.2020.06.008
Ali Alsagheir5
Estimated H-index: 5
(McMaster University),
Alex Koziarz8
Estimated H-index: 8
(U of T: University of Toronto)
+ 6 AuthorsOsami Honjo22
Estimated H-index: 22
Sources
Abstract
Abstract Objective The aim of this systematic review and meta-analysis is to evaluate whether duct stenting (DS) is associated with better survival and other clinical outcomes compared to modified Blalock-Taussig shunt (BTS) in infants with a duct-dependent pulmonary flow. Methods A systematic search of Medline, Embase, and Cochrane databases was performed by four independent reviewers from inception to March 2019. Meta-analysis was performed using DerSimonian and Laird method with inverse-variance weighting. The quality of evidence was summarized using the GRADE framework. Results Six comparative observational studies were included, of which three were rated low risk of bias. There was no difference in 30-day mortality between BTS and DS (risk ratio [RR]: 1.02, 95% CI: 0.46 to 2.27, P=.96, I2=0%). However, there was benefit in favour for DS for medium-term mortality (RR: 0.63, 95% CI: 0.40 to 0.99, P=.05, I2=0%). DS demonstrated a reduced risk for procedural complications compared to BTS (RR: 0.50, 95% CI: 0.31 to 0.81, P=.005, I2=0%). However, there was an increased risk for unplanned re-intervention for DS (RR: 1.77, 95% CI: 1.39 to 2.26, P Conclusions DS demonstrated comparable early mortality, lower medium-term mortality, lower risk of procedural complications, and higher risk of re-intervention compared to BTS.
📖 Papers frequently viewed together
20 Citations
9 Citations
44 Citations
References24
Newest
#1Dana M. Boucek (UPenn: University of Pennsylvania)H-Index: 1
#2Athar M. Qureshi (BCM: Baylor College of Medicine)H-Index: 18
Last. Andrew C. Glatz (UPenn: University of Pennsylvania)H-Index: 30
view all 5 authors...
BACKGROUND: Infants with ductal-dependent pulmonary blood flow (PBF) often undergo a palliative procedure to provide a stable source of PBF prior to definitive palliation or repair. In the current era, a surgical shunt or ductal stent is used to provide PBF. We aimed to review the current literature comparing ductal stents to surgical shunts. METHODS AND RESULTS: Four small, single-center studies and two larger multicenter studies were identified comparing ductal stent to surgical shunt. Combine...
12 CitationsSource
#1Lee N. BensonH-Index: 74
#2Glen S. Van Arsdell (U of T: University of Toronto)H-Index: 52
Articles, see p 581 and p 589 > Nothing is as powerful as an idea whose time has come. > > —Victor Hugo, Histoire d’un Crime (1852) On November 29, 1944, Dr Alfred Blalock performed the first anastomosis of the subclavian to the pulmonary artery in a child with cyanosis at the Johns Hopkins Hospital in Baltimore. This novel operation was supported by the laboratory work of Vivien Thomas and the encouragement of pediatric cardiologist Helen Taussig. The operation, thereafter called the Blalock-Ta...
7 CitationsSource
#1James R. Bentham (LGI: Leeds General Infirmary)H-Index: 5
#2Ngoni K. Zava (LGI: Leeds General Infirmary)H-Index: 1
Last. John Thomson (LGI: Leeds General Infirmary)H-Index: 19
view all 19 authors...
Background:Infants born with cardiac abnormalities causing dependence on the arterial duct for pulmonary blood flow are often palliated with a shunt usually between the subclavian artery and either...
68 CitationsSource
#1Andrew C. Glatz (UPenn: University of Pennsylvania)H-Index: 30
#2Christopher J. Petit (Emory University)H-Index: 12
Last. Athar M. Qureshi (BCM: Baylor College of Medicine)H-Index: 18
view all 17 authors...
Background: Infants with ductal-dependent pulmonary blood flow may undergo palliation with either a patent ductus arteriosus (PDA) stent or a modified Blalock-Taussig (BT) shunt. A balanced multicenter comparison of these 2 approaches is lacking. Methods: Infants with ductal-dependent pulmonary blood flow palliated with either a PDA stent or a BT shunt from January 2008 to November 2015 were reviewed from the 4 member centers of the Congenital Catheterization Research Collaborative. Outcomes wer...
77 CitationsSource
#1Navaneetha Sasikumar (U of T: University of Toronto)H-Index: 1
#2Antony Hermuzi (U of T: University of Toronto)H-Index: 1
Last. Lee N. Benson (U of T: University of Toronto)H-Index: 74
view all 11 authors...
Objectives Mortality associated with the modified Blalock–Taussig shunt (MBTS) remains high despite advanced perioperative management. This study was formulated to provide data on (1) current indications, (2) outcomes, and (3) factors affecting mortality and morbidity. Design A retrospective single center chart review identified 95 children (excluding hypoplastic left heart lesions) requiring a MBTS. Mortality and major morbidity were analyzed using the Kaplan Meier method and risk factor analys...
19 CitationsSource
#1Kiran K. Mallula (UCSD: University of California, San Diego)H-Index: 2
#2Gabrielle Vaughn (UCSD: University of California, San Diego)H-Index: 4
Last. John W. Moore (UCSD: University of California, San Diego)H-Index: 33
view all 5 authors...
Objectives We sought to compare ductal stenting (DS) to systemic-pulmonary artery shunt (SPS) in a contemporary cohort of patients having pulmonary atresia with intact ventricular septum (PAIVS). Background Alternative palliative strategies (interventional versus surgical) are currently available for initial palliation of ductal dependent patients with various forms of congenital heart disease. There is little data available to guide strategy selection. Methods A retrospective review of patients...
36 CitationsSource
#1David Michael McMullan (Seattle Children's)H-Index: 8
#2Lester C. Permut (Seattle Children's)H-Index: 8
Last. Agustin E. Rubio (Seattle Children's)H-Index: 4
view all 5 authors...
Objective The modified Blalock-Taussig shunt is the most commonly used palliative procedure for infants with ductal-dependent pulmonary circulation. Recently, catheter-based stenting of the ductus arteriosus has been used by some centers to avoid surgical shunt placement. We evaluated the durability and safety of ductal stenting as an alternative to the modified Blalock-Taussig shunt. Methods A single-institution, retrospective review of patients undergoing modified Blalock-Taussig shunt versus ...
46 CitationsSource
#1Hamid Amoozgar (Shiraz University of Medical Sciences)H-Index: 13
#2Sirous Cheriki (Shiraz University of Medical Sciences)H-Index: 6
Last. Amirali Amirghofran (Shiraz University of Medical Sciences)H-Index: 1
view all 8 authors...
This report aims to compare the researchers’ early experience with the safety, efficacy, short-term outcomes, and complications of patent ductus arteriosus (PDA) stents in neonates having duct-dependent pulmonary circulation with those of surgically created shunts. Between April 2009 and April 2011, 18 infants with duct-dependent pulmonary circulation underwent cardiac catheterization for PDA stenting as the first palliative procedure in a referral center. For comparison, 20 infants who underwen...
31 CitationsSource
#1Vladimiro L. Vida (UNIPD: University of Padua)H-Index: 28
#2Simone Speggiorin (UNIPD: University of Padua)H-Index: 7
Last. Giovanni Stellin (UNIPD: University of Padua)H-Index: 51
view all 9 authors...
Background Stenting of the patent ductus arteriosus (PDA) has been recently introduced to palliate patients with duct-dependent pulmonary circulations. We evaluated the surgical outcome of patients who had a previous PDA stent, focusing on their pulmonary arteries status. Methods This study included 15 patients (11 boys, 4 girls) who underwent cardiac operations after PDA stenting between August 2004 and April 2009. Outcomes included hospital mortality, morbidity, and need for reintervention or ...
26 CitationsSource
#1Giuseppe Santoro (Seconda Università degli Studi di Napoli)H-Index: 21
#2Giovanbattista Capozzi (Seconda Università degli Studi di Napoli)H-Index: 9
Last. Raffaele Calabrò (Seconda Università degli Studi di Napoli)H-Index: 65
view all 8 authors...
Objectives The aim of this study was to compare the pulmonary artery (PA) growth after arterial duct (AD) stenting versus modified Blalock-Taussig shunt (MBTS) in neonates with congenital heart disease with duct-dependent pulmonary circulation (CHD-DPC). Background Arterial duct stenting is increasingly deemed a reliable alternative to surgical shunt in CHD-DPC. A stented duct might better adapt to the PA anatomy than a surgical conduit, thereby promoting a more uniform PA development. Methods T...
63 CitationsSource
Cited By7
Newest
Source
#1Worakan PromphanH-Index: 8
#2Shakeel A. QureshiH-Index: 1
The ductal stenting (DS) is currently an acceptable palliative treatment in newborns suffering with duct-dependent pulmonary circulation. However, this procedure remains technically a challenge in complex ductal morphology, which may eventually lead to detrimental outcomes. This review is mainly focused on pre-procedural planning, essential instruments and practical approaches for DS, and post-procedural care.
1 CitationsSource
#1Adeolu Banjoko (University of Birmingham)
#2Golnoush Seyedzenouzi (St George's, University of London)H-Index: 3
Last. Amer HarkyH-Index: 17
view all 9 authors...
Surgical repair of Tetralogy of Fallot has excellent outcomes, with over 90% of patients alive at 30 years. The ideal time for surgical repair is between 3 and 11 months of age. However, the symptomatic neonate with Tetralogy of Fallot may require earlier intervention: either a palliative intervention (right ventricular outflow tract stent, ductal stent, balloon pulmonary valvuloplasty, or Blalock-Taussig shunt) followed by a surgical repair later on, or a complete surgical repair in the neonata...
Source
Source
#1James M. Meza (Duke University)H-Index: 14
#2Neel K. Prabhu (Duke University)H-Index: 4
Last. Nicholas D. Andersen (Duke University)H-Index: 25
view all 5 authors...
Source
#1David G. Lehenbauer (Cincinnati Children's Hospital Medical Center)H-Index: 2
#2David L.S. Morales (Cincinnati Children's Hospital Medical Center)H-Index: 54
Source
The controversy regarding the best or ideal surgical management of Tetralogy of Fallot (ToF) stems from the recognition of there being a spectrum of morphology and associated lesions, each of which require a different approach to achieve the three goals of minimizing mortality preserving right ventricular function long-term and minimizing reinterventions. A one-size-fits-all approach to ToF needs to be replaced by a considered and personalized approach in order to yield the best outcomes possibl...
Source