Blalock-Taussig shunt versus patent ductus arteriosus stent as first palliation for ductal-dependent pulmonary circulation lesions: A review of the literature

Abstract

Background Infants with ductal‐dependent pulmonary blood flow (PBF) often undergo a palliative procedure to provide a stable source of PBF prior to definitive palliation or repair. In the current era, a surgical shunt or ductal stent is used to provide PBF. We aimed to review the current literature comparing ductal stents to surgical shunts. Methods and Results Four small, single‐center studies and two larger multicenter studies were identified comparing ductal stent to surgical shunt. Combined, these studies showed ductal stent resulted in similar or improved pulmonary artery growth, fewer complications, shorter length of stay, less diuretic use, and improved survival compared to surgical shunt. Despite inherent minor variability among the studies, ductal stent appears to be associated with more frequent reinterventions. Conclusions Surgical shunts remain essential to the care of these patients, but ductal stent is a reasonable alternative, and may provide some advantages in select patients with ductal‐dependent PBF.

The Challenges of Swimming Against the Tide

“…As for pulmonary artery growth, a number of studies have examined that and have showed either equivalent or superior and more symmetrical growth of the branch pulmonary arteries following DS compared to mBTS. [7][8][9] This new study from Duke University is definitely in line with the findings from previously published reports.…”

“…In the past decade, there have been a number of single-center and multi-institutional reports that compared outcomes between infants who received mBTS versus DS, and they showed that DS were associated with either equivalent or superior outcomes. [6][7][8] Overall, it seems that patients who receive DS may be expected to recover faster than those who receive mBTS, to require shorter mechanical ventilation, intensive care unit or hospital stay durations, and to have lower complications including cardiac arrest or ECMO need. Additionally, some of these reports have shown decreased early intervention with DS compared to mBTS, and some have shown decreased procedure mortality and improved overall survival toward subsequent planned operation with DS compared to mBTS.…”

Use of the ductal curvature index to assess the risk of ductal stenting in patients with duct-dependent pulmonary circulation

“…Use of the ductal curvature index to assess the risk of ductal stenting in patients with duct-dependent pulmonary circulation patients the need for thoracotomy and reduce postoperative complications as well as asymmetrical development of pulmonary arteries. Additionally, it reduces the mortality rate and the need for extracorporeal membrane oxygenation (ECMO) (9)(10)(11)(12)(13). Despite the new developments in the field of coronary stents and the introduction of drug eluting stents that minimise in-stent stenosis and prolong the stent patency (12,14), stenting of ducts with increased tortuosity ,especially when associated with pulmonary stenosis, is still challenging and fraught with risks (15)(16)(17).…”

Tricuspid atresia: Where are we now?

“…Reports of refractory cardiac arrest following shunt insertion have even been described 27 . Ductal stenting is a reasonable alternative to the MBTS, as it is associated with similar or improved pulmonary artery growth, fewer complications, a shorter length of stay, and improved survival 30 …”