Blalock-Taussig Shunt versus Ductal Stenting as Palliation for Duct-Dependent Pulmonary Circulation

Al Kindi, Hamood; Al Harthi, Hasina; Al Balushi, Asim; Atiq, Ahlam; Shaikh, Samiuddin; Al Alawi, Khalid; Al-Farqani, Abdullah

doi:10.18295/squmj.12.2023.073

Cited by 3 publications

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References 23 publications

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“…Слід зазначити, що в нашому дослідженні відсоток загальної летальності у групі ІІ був значно нижчий, ніж у групі І -14,9 проти 26,8 %. Виживаність пацієнтів після стентування ВАП значно вища, ніж при накладанні СЛА, особливо в новонароджених з малою вагою тіла чи супутньою патологією [8]. Однак анастомоз є варіантом вибору в пацієнтів, що мають складну анатомію ВАП, при якій безпечна та ефективна імплантація стента неможлива.…”

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Comparison of the Effectiveness of Ductus Arteriosus Stenting and Systemic-to-Pulmonary Artery Shunt Placement in a Cohort of Newborns with Duct-Dependent Pulmonary Circulation

Mykhailovska,

Motrechko,

Kurkevych

et al. 2024

ujcvs

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In newborns with congenital heart defects and duct-dependent pulmonary circulation, the first stage of palliative intervention may involve the systemic-to-pulmonary artery shunt (SPAS) placement or the patent ductus arteriosus (PDA) stenting. SPAS placement is a traditional method, but the trend towards reducing the invasiveness of surgical interventions has led to PDA stenting use as a preferred method to ensure a reliable source of pulmonary blood flow. The aim. To compare pre- and postoperative indicators, complications, and long-term outcomes in two groups of patients after SPAS placement and PDA stenting. Materials and methods. This single-center retrospective study included 82 newborns who underwent SPAS placement (Group I) and 47 patients who underwent PDA stenting (Group II) from 2015 to 2023. Baseline clinical data were similar in both groups. The arterial blood oxygen saturation (SaO2) was significantly lower in the PDA stenting group compared to the SPAS group (65.7 ± 11.1% vs. 79.2 ± 10.6%, respectively) (p < 0.00001). There was higher percentage of genetic/concomitant pathology in Group II, 13 (27.6%) versus 10 (12.2%), p = 0.02. Results. There was no statistically significant difference between the analyzed patient groups in clinical status indicators in the postoperative period, including: the duration of artificial lung ventilation (165.5 ± 94 and 150 ± 113 in groups I and II, respectively) (p = 0.87) and length of stay in the intensive care unit (14 ± 7 and 13.6 ± 9.4 days) (p = 0.76). However, SaO2 was higher in Group I than in Group II (81 ± 5.5% vs. 85 ± 4.6%, respectively) (p = 0.02). Before the next stage of surgical correction, the Nakata index in Group II was significantly higher than that in Group I (225 ± 87.4 mm2/m2 vs. 168 ± 35.9 mm2/m2, respectively) (p = 0.048). The percentage of reoperations was higher in Group II (17 [36.1%] versus 14 [17.1%]), however, the overall (14.9% and 26.8%) and late (9.1% and 19.5%) mortality rates were lower in Group II. Conclusion. Considering the similar results in both patient groups, stenting may be an effective option to increase the pulmonary blood flow in newborns. Due to its minimally invasive procedure, this method may be a choice for premature newborns and children with complex comorbidities. However, SPAS placement remains an important palliative intervention, particularly in cases where ductus arteriosus is tortuous and in congenital heart defects with complex intracardiac anatomy postponing radical correction until older age.

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Comparison of the Effectiveness of Ductus Arteriosus Stenting and Systemic-to-Pulmonary Artery Shunt Placement in a Cohort of Newborns with Duct-Dependent Pulmonary Circulation

Mykhailovska,

Motrechko,

Kurkevych

et al. 2024

ujcvs

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Experience of Performing Systemic-to-Pulmonary Artery Shunt in Patients with Univentricular Heart Physiology and Depleted Pulmonary Blood Flow

Imanov,

Dziuryi,

Truba

et al. 2024

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Among patients with congenital heart disease diagnosed in infancy, 7.7% of infants have anatomical variants with functional single ventricle physiology which is often accompanied by depleted pulmonary blood flow. The type of these defects is clinically associated with cyanosis, in most cases caused not by mixing of blood at the level of the heart chambers, but by the presence of ductal-dependent pulmonary blood flow, which requires urgent surgical intervention. The aim. To evaluate the immediate and long-term outcomes of hemodynamic correction in patients with single-ventricle heart physiology with depleted pulmonary blood flow. Materials and methods. In the period from 2010 to 2022, 114 patients with reduced pulmonary blood flow underwent systemic-pulmonary anastomosis at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Among these, 64 patients had biventricular circulation and subsequently underwent radical correction. The other 50 patients had single-ventricular heart physiology and underwent placement of systemic-pulmonary anastomosis as the first stage of the hemodynamic strategy according to Fontaine, so their data became the main material of this study. Results. Hospital mortality after systemic-pulmonary anastomosis was 8% (4 patients). An uncomplicated course of the early postoperative period was observed in 38 (76%) patients, and 16 complications were observed in the remaining 12 (24%) patients. The median follow-up period was 40 [3; 160] months. During the follow-up period, 2 (4.3%) patients died due to anastomosis thrombosis as a result of self-discontinuation of anticoagulant therapy, 3 (6.5%) patients were lost to follow-up and did not come for examination. The second stage of hemodynamic correction in the form of bidirectional cavopulmonary anastomosis was performed in 41 (82%) patients of the study group. Conclusions. Patients with single-ventricular heart physiology with depleted pulmonary blood flow are a group of extremely complex children who require an individual approach at all stages of hemodynamic correction, and early diagnosis and palliative systemic-pulmonary anastomosis continues to be a reliable alternative for these children, despite the fact that mortality after the first stage remains quite high.

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Patent Ductus Arteriosus Stenting in Newborns and Infants With Cyanotic Congenital Heart Defects: Experience and Outcomes

Motrechko

2024

Med. Sci. of Ukr.

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Background. Among all congenital heart defects (CHD), one-third are cyanotic defects with duct-dependent pulmonary blood flow. Palliative interventions are necessary for children with complex cyanotic CHD, premature infants, and children with complex comorbidities. Ensuring a reliable source of pulmonary blood flow adequate for arterial oxygenation and native pulmonary artery branches growth are the primary goals of staged interventions. The classic approach to providing adequate pulmonary blood flow before total repair is systemic-to-pulmonary artery shunting. Currently, there is a growing trend towards the use of an alternative method - transcatheter patent ductus arteriosus (PDA) stenting. Aim: Demonstrate the experience of PDA stenting, immediate and long-term outcomes in newborns and infants. Materials and Methods. From 2009 to April 2024, PDA stenting was performed in 66 patients at the UCC. Among the all cohort, 49 (74.2%) were newborns (Group I), and 17 (25.7%) were infants (Group II). The average age was: Group I - 7.4±5.9 days (range 1 to 28 days), and Group II - 105.2±54.78 days (range 42 to 280 days). The average weight was: Group I - 3.0±0.49 kg (range 1.9 to 4.4 kg), and Group II - 5.2±1.4 kg (range 2.7 to 9 kg). This study analyzed pre-, intra-, and postoperative parameters including age, weight, presence of concomitant/genetic pathology, saturation level, pulmonary artery branches diameter, Nakata index, PDAs size, origin and type, duration of staying in the intensive care unit, duration of artificial lung ventilation and inotropic support, early and late postoperative complications, 30-day and inter-stage mortality rates in the two patient groups. Results. All cases of transcatheter stent implantation were performed by transfemoral access. The average ICU stay duration for Group I was 13.8±9.52 days (range 2 to 119 days), and for Group II was 6.4±3.64 days (range 2 to 20 days). The duration of artificial lung ventilation in Group I was 185.8±165.28 hours (range 2 to 2066 hours), and in Group II was 67.5±46.15 hours (range 4 to 248 hours). Inotropic support - on average for Group I - 151.6±81.06 hours (range 0 to 720 hours), and for Group II - 82.4±47 hours (range 0 to 211 hours). Saturation increased from an average of 65.7±11.03% to 85.2±5.7% in Group I (p<0.05), and from 66.8±10.9% to 87.4±4.24% in Group II (p<0.05). Early postoperative complications were observed in 34.6% (17/49) of Group I patients and 23.5% (4/17) of Group II patients. The early 30-day mortality rate was 8.1% (4/49) for Group I. The next stage of surgical treatment wasperformed on average after 12.9±10.2 months by 51% (25/49) of Group I patients and by 88% (15/17) of Group II patients, on average after 14.98±12 months post-stenting. The interstage (late) mortality rate was 6.1% (3/49) for Group I and 5.8% (1/17) for Group II. Conclusion. Considering the outcomes after PDA stenting in our cohort of patients, this procedure appears to be an effective operation for providing a reliable source of pulmonary blood flow in various anatomical variants of cyanotic CHD in both newborns and infants.

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Blalock-Taussig Shunt versus Ductal Stenting as Palliation for Duct-Dependent Pulmonary Circulation

Cited by 3 publications

References 23 publications

Comparison of the Effectiveness of Ductus Arteriosus Stenting and Systemic-to-Pulmonary Artery Shunt Placement in a Cohort of Newborns with Duct-Dependent Pulmonary Circulation

Comparison of the Effectiveness of Ductus Arteriosus Stenting and Systemic-to-Pulmonary Artery Shunt Placement in a Cohort of Newborns with Duct-Dependent Pulmonary Circulation

Experience of Performing Systemic-to-Pulmonary Artery Shunt in Patients with Univentricular Heart Physiology and Depleted Pulmonary Blood Flow

Patent Ductus Arteriosus Stenting in Newborns and Infants With Cyanotic Congenital Heart Defects: Experience and Outcomes

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