Duct Stenting vs. Modified Blalock-Taussig Shunt: New Insights Learned From High-Risk Patients With Duct-Dependent Pulmonary Circulation

Frontiers in Cardiovascular Medicine

article

Nathalie Mini¹  Martin B. E. Schneider¹  Boulos Asfour²  Marian Mikus³  Peter A. Zartner¹ 

[1] Department of Cardiology, German Pediatric Heart Center, University Hospital of Bonn;Department of Pediatric Cardiac Surgery, German Pediatric Heart Center, University Hospital of Bonn;Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn

关键词: duct stenting;    mBT shunt;    sinusoid blood flow;    duct-dependent pulmonary circulation;    ductal curvature index;    tortuosity index;    pulmonary atresia (PA);   

DOI  :  10.3389/fcvm.2022.933959

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background As no data were available on the comparison of outcomes between modified Blalock-Taussig shunts (MBTs) vs. duct-stenting (DS) in patients with pulmonary atresia (PA) and an increased ductal tortuosity and in patients with pulmonary atresia and intact septum (PA-IVS) with right ventricle-dependent coronary circulation (RVDCC), we aimed to perform a single-center retrospective evaluation. Methods Between 2010 and 2019, 127 patients with duct-dependent pulmonary circulation (DDPC) underwent either MBTs (without additional repairs) ( n = 56) or DS ( n = 71). The primary endpoint was defined as arriving at the next planned surgery (Glenn or biventricular repair) avoiding one of the following: (1) unplanned surgery or unplanned perforation of the pulmonary valve (PVP) with a stent, (2) procedure-related permanent complications, and (3) death. Two subgroups were considered: (1) patients who had a ductal curvature index (DCI) >0.45 ( n = 32) and (2) patients with PA-IVS and RVDCC ( n = 13). Ductal curvature index (DCI) was measured in all the patients to assess the tortuosity of the ducts. Patients with DCI >0.45 were considered as being in a high-risk group for the duct-stenting; a previous study showed that the patients with a DCI 0.45. Results The primary outcome was achieved equally in the two groups (77.5% in DS, 75% in MBTs). Hospital deaths, need for ECMO, and the occurrence of major complications was more frequent in the group with MBTs with an Odds Ratio (OR) of 5, 0.8, and 4, respectively, and a 95% Confidence Interval ( CI ) 1.1–22.6, 0.7–0.9, and 1.6–10.3, respectively, and a P -value 0.45 who received MBTs compared to 20% in those with DS (OR 3.5, 95% CI 1.2–10, P 0.005). While 74.1% of the patients with PA-IVS and RVDCC after DS had achieved the primary outcome, all patients with MBTs had an impaired outcome (OR 3.5, 95% CI 1–11.2, P 0.004). Conclusion MBTs showed a better outcome in patients with tortuous ducts compared to DS. DS seems to be superior in patients with DDPC with DCI <0.45 and patients with PA-IVS with RVDCC.

【 授权许可】

CC BY