Modified Blalock-Taussig shunt versus ductal stenting for palliation of cardiac lesions with inadequate pulmonary blood flow.
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 ductal stenting was performed. Survival, procedural complications, and freedom from reintervention were the primary outcome variables.


RESULTS
A total of 42 shunted and 13 stented patients with similar age and weight were identified. Survival to second-stage palliation, definitive repair, or 12 months was similar between the 2 groups (88% vs 85%; P = .742). The incidence of surgical or catheter-based reintervention to maintain adequate pulmonary blood flow was 26% in the shunted patients and 25% in the stented patients (P = 1.000). Three shunted patients (7%) required intervention to address contralateral pulmonary artery stenosis and 3 (7%) required surgical reintervention to address nonpulmonary blood flow-related complications. The need for ipsilateral or juxtaductal pulmonary artery intervention at, or subsequent to, second-stage palliation or definitive repair was similar between the 2 groups.


CONCLUSIONS
Freedom from reintervention to maintain adequate pulmonary blood flow was similar between infants undergoing modified Blalock-Taussig shunt or ductal stenting as an initial palliative procedure. However, a greater percentage of shunted patients experienced procedure-related complications and distal branch pulmonary artery stenosis. Palliative ductal stenting appears to be a safe and effective alternative to modified Blalock-Taussig in selected infants.
Division of Pediatric Cardiac Surgery, Seattle Children's Hospital, Seattle, Wash. Electronic address: michael.mcmullan@seattlechildrens.org.
David Michael
DM
McMullan
Division of Pediatric Cardiac Surgery, Seattle Children's Hospital, Seattle, Wash.
Lester Cal
LC
Permut
Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Wash.
Thomas Kenny
TK
Jones
Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Wash.
Troy Alan
TA
Johnston
Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Wash.
Agustin Eduardo
AE
Rubio
D058366:Blalock-Taussig Procedure / Q000009:adverse effects / Q000401:mortality; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D004373:Ductus Arteriosus / Q000503:physiopathology*; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D010166:Palliative Care / Q000379:methods*; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
20; 28; DS; STS; Society of Thoracic Surgeons; ductal stenting; mBTS; modified Blalock-Taussig systemic-to-pulmonary shunt