Modified Blalock-Taussig shunt versus ductal stenting for palliation of cardiac lesions with inadequate pulmonary blood flow

David Michael McMullan; Lester Cal Permut; Thomas Kenny Jones; Troy Alan Johnston; Agustin Eduardo Rubio

doi:10.1016/j.jtcvs.2013.07.052

Modified Blalock-Taussig shunt versus ductal stenting for palliation of cardiac lesions with inadequate pulmonary blood flow

J Thorac Cardiovasc Surg. 2014 Jan;147(1):397-401. doi: 10.1016/j.jtcvs.2013.07.052. Epub 2013 Sep 23.

Authors

David Michael McMullan¹, Lester Cal Permut², Thomas Kenny Jones³, Troy Alan Johnston³, Agustin Eduardo Rubio³

Affiliations

¹ Division of Pediatric Cardiac Surgery, Seattle Children's Hospital, Seattle, Wash. Electronic address: michael.mcmullan@seattlechildrens.org.
² Division of Pediatric Cardiac Surgery, Seattle Children's Hospital, Seattle, Wash.
³ Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Wash.

PMID: 24071469
DOI: 10.1016/j.jtcvs.2013.07.052

Abstract

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.

Keywords: 20; 28; DS; STS; Society of Thoracic Surgeons; ductal stenting; mBTS; modified Blalock-Taussig systemic-to-pulmonary shunt.

Publication types

Comparative Study

MeSH terms

Blalock-Taussig Procedure* / adverse effects
Blalock-Taussig Procedure* / mortality
Cardiac Catheterization / adverse effects
Cardiac Catheterization / instrumentation*
Cardiac Catheterization / mortality
Ductus Arteriosus / physiopathology*
Heart Defects, Congenital / diagnosis
Heart Defects, Congenital / mortality
Heart Defects, Congenital / physiopathology
Heart Defects, Congenital / therapy*
Hospital Mortality
Humans
Infant
Infant, Newborn
Kaplan-Meier Estimate
Palliative Care / methods*
Patient Selection
Postoperative Complications / mortality
Postoperative Complications / therapy
Pulmonary Circulation*
Retrospective Studies
Stents*
Time Factors
Treatment Outcome