Skip to main content
SpringerLink
Log in

Early and Long-Term Clinical Outcomes of Ductal Stenting Versus Surgical Aortopulmonary Shunt Among Young Infants with Duct-Dependent Pulmonary Circulation

  • Research
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Surgical aortopulmonary shunting (SAPS) and ductal stenting (DS) are the main palliations in infants with cyanotic congenital heart diseases (CHD). We aimed to study the safety and efficacy of DS and to compare it with SAPS as a palliative procedure in infants with CHD and duct-dependent pulmonary circulation. Retrospective institutional clinical data review of consecutive infants aged < 3 months who underwent DS or SAPS over 5 years. The primary outcome was procedural success which was defined as event-free survival (mortality, need for re-intervention, procedural failure) at 30 days post-procedure. The secondary outcome was defined by a composite of death, major adverse cardiovascular events, or need for re-intervention at 6 months and on long-term follow-up. We included 102 infants (DS, n = 53 and SAPS, n = 49). The median age at DS and SAPS was 4 days (IQR 2.0–8.5) and 8 days (IQR 4.0–39.0), respectively. The median weight at intervention was 3.0 kg (IQR 3.0–3.0) and 3.0 kg (IQR 2.5–3.0) in the two respective arms. Tetralogy of Fallot with pulmonary atresia was the most common indication for DS and SAPS. The 30-day mortality was significantly higher in SAPS group as compared with DS group (p < 0.05). However, 30-day major adverse cardiac events (MACE) rates were similar in both groups (p = 0.29). DS was associated with shorter duration of mechanical ventilation, duration of stay in the intensive care and hospital stay than with SAPS. At 6 months, there was no significant difference in terms of mortality or event-free survival. Long-term MACE-free survival was also comparable (p = 0.13). DS is an effective and safer alternative to SAPS in infants with duct-dependent pulmonary circulation, offering reduced procedure-related mortality and morbidity than SAPS. Careful study of ductal anatomy is crucial to procedural success. However, long-term outcomes are similar in both procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

The first author and the corresponding author have the dataset pertaining to this manuscript. Patient identity particulars have not been disclosed.

Code Availability

Not applicable.

Abbreviations

CHD:

Congenital heart diseases

DS:

Ductal stenting

ICR:

Intra-cardiac repair

MACE:

Major adverse cardiac events

MBTTS:

Modified Blalock Taussig Thomas shunt

PGE1:

Prostaglandin E1

SAPS:

Surgical aortopulmonary shunt

References

  1. Gibbs JL, Rothman MT, Rees MR et al (1992) Stenting of the arterial duct: a new approach to palliation for pulmonary atresia. Br Heart J 67:240–245. https://doi.org/10.1136/hrt.67.3.240

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Garg G, Mittal DK (2018) Stenting of patent ductus arteriosus in low birth weight newborns less than 2 kg-procedural safety, feasibility and results in a retrospective study. Indian Heart J 70:709–712. https://doi.org/10.1016/j.ihj.2018.01.027

    Article  PubMed  PubMed Central  Google Scholar 

  3. Aggarwal V, Petit CJ, Glatz AC et al (2019) Stenting of the ductus arteriosus for ductal-dependent pulmonary blood flow—current techniques and procedural considerations. Congenit Heart Dis 14:110–115. https://doi.org/10.1111/chd.12709

    Article  PubMed  Google Scholar 

  4. Alwi M, Choo KK, Latiff HA et al (2004) Initial results and medium-term follow-up of stent implantation of patent ductus arteriosus in duct-dependent pulmonary circulation. J Am Coll Cardiol 44:438–445. https://doi.org/10.1016/j.jacc.2004.03.066

    Article  PubMed  Google Scholar 

  5. Mahesh K, Kannan BRJ, Vaidyanathan B et al (2005) Stenting the patent arterial duct to increase pulmonary blood flow. Indian Heart J 57:704–708

    PubMed  Google Scholar 

  6. Sagar P, Sivakumar K, Umamaheshwar KL et al (2021) Are early palliative procedures providing an adequate long-term benefit in young cyanotic infants from developing countries, despite advances in surgery and interventions? Cardiol Young 31:358–370. https://doi.org/10.1017/S1047951120003947

    Article  PubMed  Google Scholar 

  7. Bentham JR, Zava NK, Harrison WJ et al (2018) Duct stenting versus modified Blalock-Taussig shunt in neonates with duct-dependent pulmonary blood flow. Circulation 137:581–588. https://doi.org/10.1161/CIRCULATIONAHA.117.028972

    Article  PubMed  Google Scholar 

  8. Ratnayaka K, Nageotte SJ, Moore JW et al (2021) Patent ductus arteriosus stenting for all ductal-dependent cyanotic infants. Circ Cardiovasc Interv 14:e009520. https://doi.org/10.1161/CIRCINTERVENTIONS.120.009520

    Article  PubMed  Google Scholar 

  9. Haddad RN, Hanna N, Charbel R et al (2019) Ductal stenting to improve pulmonary blood flow in pulmonary atresia with intact ventricular septum and critical pulmonary stenosis after balloon valvuloplasty. Cardiol Young 29:492–498. https://doi.org/10.1017/S1047951119000118

    Article  PubMed  Google Scholar 

  10. Alsoufi B, Gillespie S, Mori M et al (2016) Factors affecting death and progression towards next stage following modified Blalock-Taussig shunt in neonates. Eur J Cardiothorac Surg 50:169–177. https://doi.org/10.1093/ejcts/ezw017

    Article  PubMed  Google Scholar 

  11. Bauser-Heaton H, Qureshi AM, Goldstein BH et al (2022) Comparison of patent ductus arteriosus stent and Blalock-Taussig shunt as palliation for neonates with sole source ductal-dependent pulmonary blood flow: results from the congenital catheterization research collaborative. Pediatr Cardiol 43:121–131. https://doi.org/10.1007/s00246-021-02699-7

    Article  PubMed  Google Scholar 

  12. Ghaderian M, Behdad S, Mokhtari M, Salamati L (2023) Comparison of patent ductus arteriosus stenting and Blalock-Taussig shunt in ductal dependent blood flow congenital heart disease and decreased pulmonary blood flow. Heart Views 24:11–16. https://doi.org/10.4103/heartviews.heartviews_84_22

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tseng SY, Truong VT, Peck D et al (2022) Patent ductus arteriosus stent versus surgical aortopulmonary shunt for initial palliation of cyanotic congenital heart disease with ductal-dependent pulmonary blood flow: a systematic review and meta-analysis. J Am Heart Assoc 11:e024721. https://doi.org/10.1161/JAHA.121.024721

    Article  PubMed  PubMed Central  Google Scholar 

  14. Alsagheir A, Koziarz A, Makhdoum A et al (2021) Duct stenting versus modified Blalock-Taussig shunt in neonates and infants with duct-dependent pulmonary blood flow: a systematic review and meta-analysis. J Thorac Cardiovasc Surg 161:379-390.e8. https://doi.org/10.1016/j.jtcvs.2020.06.008

    Article  PubMed  Google Scholar 

  15. Boucek DM, Qureshi AM, Goldstein BH et al (2019) Blalock-Taussig shunt versus patent ductus arteriosus stent as first palliation for ductal-dependent pulmonary circulation lesions: a review of the literature. Congenit Heart Dis 14:105–109. https://doi.org/10.1111/chd.12707

    Article  PubMed  Google Scholar 

  16. Helal AM, Elmahrouk AF, Bekheet S et al (2022) Patent ductus arteriosus stenting versus modified Blalock-Taussig shunt for palliation of duct-dependent pulmonary blood flow lesions. J Card Surg 37:2571–2580. https://doi.org/10.1111/jocs.16692

    Article  PubMed  Google Scholar 

  17. Santoro G, Capozzi G, Caianiello G et al (2009) Pulmonary artery growth after palliation of congenital heart disease with duct-dependent pulmonary circulation: arterial duct stenting versus surgical shunt. J Am Coll Cardiol 54:2180–2186. https://doi.org/10.1016/j.jacc.2009.07.043

    Article  PubMed  Google Scholar 

  18. Shahanavaz S, Qureshi AM, Petit CJ et al (2021) Factors influencing reintervention following ductal artery stent implantation for ductal-dependent pulmonary blood flow: results from the congenital cardiac research collaborative. Circ Cardiovasc Interv 14:e010086. https://doi.org/10.1161/CIRCINTERVENTIONS.120.010086

    Article  PubMed  Google Scholar 

  19. Kurup HKN, Gopalakrishnan A, Sasikumar D, Krishnamoorthy KM (2023) Safety of drug-eluting stents for stenting patent arterial duct in neonates. Cardiol Young 33:437–443. https://doi.org/10.1017/S104795112200110X

    Article  PubMed  Google Scholar 

  20. Goldstein BH, O’Byrne ML, Petit CJ et al (2019) Differences in cost of care by palliation strategy for infants with ductal-dependent pulmonary blood flow. Circ Cardiovasc Interv 12:e007232. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007232

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Nil.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Christian Medical College and Hospital, Ludhiana, Punjab, India

    Gurbhej Singh

  2. Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

    Arun Gopalakrishnan, Venkateshwaran Subramanian, Deepa Sasikumar, Bijulal Sasidharan, Baiju S. Dharan, B. V. Srinivasa Prasad, Sabarinath Menon, Ajitkumar Valaparambil, Kavassery Mahadevan Krishnamoorthy, Sivasankaran Sivasubramonian & Jaganmohan Tharakan

  3. Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India

    Arun Gopalakrishnan

Authors
  1. Gurbhej Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arun Gopalakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Venkateshwaran Subramanian
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Deepa Sasikumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bijulal Sasidharan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Baiju S. Dharan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. B. V. Srinivasa Prasad
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sabarinath Menon
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ajitkumar Valaparambil
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kavassery Mahadevan Krishnamoorthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Sivasankaran Sivasubramonian
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jaganmohan Tharakan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed significantly to this manuscript.

Corresponding author

Correspondence to Arun Gopalakrishnan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

The study was approved by the Institute Ethics Committee of Sree Chitra Tirunal Institute for Medical Sciences and Technology (IEC No. ECR/189/Inst/KL/2013) and was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its amendments.

Consent to Participate

Written informed consent was obtained from all the patients in the study in English or in their vernacular for participation in the study.

Consent for Publication

Written informed consent was obtained from all the patients in the study in English or in their vernacular for publication of the study results. Patient detail privacy has been taken care of and identity particulars have not been disclosed.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singh, G., Gopalakrishnan, A., Subramanian, V. et al. Early and Long-Term Clinical Outcomes of Ductal Stenting Versus Surgical Aortopulmonary Shunt Among Young Infants with Duct-Dependent Pulmonary Circulation. Pediatr Cardiol 45, 787–794 (2024). https://doi.org/10.1007/s00246-024-03415-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-024-03415-x

Keywords

Search

Navigation