Comparison Between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants With Ductal-Dependent Pulmonary Blood Flow

Glatz, Andrew C.; Petit, Christopher J.; Goldstein, Bryan H.; Kelleman, Michael; McCracken, Courtney; McDonnell, Alicia; Buckey, Timothy M.; Mascio, Christopher E.; Shashidharan, Subi; Ligon, R. Allen; Ao, Jingning; Whiteside, Wendy; Wallen, W. Jack; Metcalf, Christina M.; Aggarwal, Varun; Agrawal, Hitesh; Qureshi, Athar M.

doi:10.1161/circulationaha.117.029987

Cited by 194 publications

(189 citation statements)

References 33 publications

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“…Additionally, although not quite statistically significant, PDAs with Type II and Type III TI were more likely to have underlying shown in a large comparative study of surgical shunts versus PDA stents, PA size is both more symmetric and greater (using Nakata and symmetry indices) in a matched cohort of infants with ductal stents compared to the cohort with surgical shunt. 15 There are several noteworthy limitations to this study. It is important to recognize that PDAs are 3-dimensional structures and measurements made from 2D projectional angiography (obtained during these procedures from a practical standpoint), particularly with higher degrees of tortuosity, may be flawed.…”

Section: Discussionmentioning

confidence: 92%

“…A retrospective multicenter cohort study was conducted on all infants less than 1 year of age with ductal dependent PBF and confluent branch and Children's Healthcare of Atlanta. 14,15 The study cohort consisted of the PDA stent cohort from a recent publication comparing outcomes of PDA stent placement and BT shunt placement. 15 Patients with discontinuous PAs or major aorto-pulmonary collateral arteries were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…14,15 The study cohort consisted of the PDA stent cohort from a recent publication comparing outcomes of PDA stent placement and BT shunt placement. 15 Patients with discontinuous PAs or major aorto-pulmonary collateral arteries were excluded. Institutional Review Board approval was obtained for this study from each institution.…”

Section: Methodsmentioning

confidence: 99%

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Classification scheme for ductal morphology in cyanotic patients with ductal dependent pulmonary blood flow and association with outcomes of patent ductus arteriosus stenting

Qureshi

Goldstein

Glatz

et al. 2019

Cathet Cardio Intervent

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Objectives To devise a classification scheme for ductal morphology in patients with ductal dependent pulmonary blood flow (PBF) that can be used to assess outcomes. Background The impact of ductal morphology on outcomes following patent ductus arteriosus (PDA) stenting is not well defined. Methods Patients <1 year of age who underwent PDA stenting for ductal dependent PBF at the four centers comprising the Congenital Catheterization Research Collaborative (CCRC) were included. A classification scheme for PDA morphology was devised based on a tortuosity index (TI)—Type I (straight), Type II (one turn), and Type III (multiple turns). A subtype classification was used based upon the ductal origin. Results One hundred and five patients underwent PDA stenting. TI was Type I in 58, Type II in 24, and Type III in 23 PDAs, respectively. There was a significant association between ductal origin and vascular access site (p < 0.001). Procedure times and need for >1 stent did not differ based on TI. Greater TI was associated with pulmonary artery (PA) jailing (p = 0.003). Twelve (11.4%) patients underwent unplanned reintervention, more commonly with greater TI (p = 0.022) and PA jailing (p < 0.001). At the time of subsequent surgical repair/palliative staging, PA arterioplasty was performed in 32 patients, more commonly when a PA was jailed (p = 0.048). PA jailing did not affect PA size at follow up. Conclusions The proposed qualitative and quantitative PDA morphology classification scheme may be helpful in anticipating outcomes in patients with ductal dependent PBF undergoing PDA stenting.

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Section: Discussionmentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

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Classification scheme for ductal morphology in cyanotic patients with ductal dependent pulmonary blood flow and association with outcomes of patent ductus arteriosus stenting

Qureshi

Goldstein

Glatz

et al. 2019

Cathet Cardio Intervent

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“…Prospective studies comparing different approaches to securing a reliable pulmonary blood flow and shunt sizes could address some of these unresolved issues. Whether wider adaption of an interventional palliation (ductal stent or right ventricular outflow tract dilation or stenting) would help decrease mortality and morbidity compared to a MBTS in suitable children needs to be established with prospective studies …”

Section: Discussionmentioning

confidence: 99%

Outcomes of Blalock-Taussig shunts in current era: A single center experience

Sasikumar

Hermuzi

Fan

et al. 2017

Congenital Heart Disease

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“…[1][2][3][4] Recently, two studies comparing surgical BTS to PDA stenting with adjusted analyses to balance the cohorts found that infants palliated with a PDA stent had favorable outcomes. 5,6 PDA stenting was associated with lower mortality and reduced hospital length of stay, albeit with equivalent or higher rates of reintervention.…”

mentioning

confidence: 89%

Use of carotid and axillary artery approach for stenting the patent ductus arteriosus in infants with ductal‐dependent pulmonary blood flow: A multicenter study from the congenital catheterization research collaborative

Bauser‐Heaton

Qureshi

Goldstein

et al. 2019

Cathet Cardio Intervent

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Background Carotid artery (CA) and axillary artery (AA) access are increasingly used for transcatheter stenting of the patent ductus arteriosus (PDA), although reports are limited. Methods The Congenital Catheterization Research Collaborative (CCRC) reviewed multicenter data from infants who underwent PDA stenting via the CA or AA approach from 2008 to 2017, and compared outcomes to those of infants undergoing PDA stenting via the femoral artery (FA) approach. Post‐procedure ultrasound (US) imaging was reviewed. Results Forty‐nine infants underwent PDA stenting from the CA (n = 43) or AA (n = 6) approach, compared with 55 infants who underwent PDA stenting from the FA approach. The PDA was the sole pulmonary blood flow (PBF) source in 61% of infants in the CA/AA cohort, compared with 33% of the FA cohort (p < .01). Ductal tortuosity for CA/AA cohort was Type I (straight) in 10 (20%), Type II (one turn) in 17 (35%), and Type III (multiple turns) in 22 (45%) infants and reflected a greater degree of tortuosity when compared to the FA cohort (p < .01). In 17 infants with CA/AA approach, the “flip technique” was used, and was associated with shorter procedure times for highly tortuous PDA (Type III) patients. Rates of procedural complications were similar across access sites. Most common complications were access site injury (thrombus or bleeding) and stent malposition. No complications were specifically related to the “flip technique.” Conclusions Use of CA and AA approach for PDA stenting was found to be more commonly employed in sole source PBF and highly tortuous PDAs. Procedural modifications such as the “flip technique” may lead to shorter procedure times. CA and AA approaches are associated with a similar burden of procedural or late complications. Post‐procedural surveillance of the CA and AA is suggested, given the incidence of vascular findings on US.

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Comparison Between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants With Ductal-Dependent Pulmonary Blood Flow

Cited by 194 publications

References 33 publications

Classification scheme for ductal morphology in cyanotic patients with ductal dependent pulmonary blood flow and association with outcomes of patent ductus arteriosus stenting

Classification scheme for ductal morphology in cyanotic patients with ductal dependent pulmonary blood flow and association with outcomes of patent ductus arteriosus stenting

Outcomes of Blalock-Taussig shunts in current era: A single center experience

Use of carotid and axillary artery approach for stenting the patent ductus arteriosus in infants with ductal‐dependent pulmonary blood flow: A multicenter study from the congenital catheterization research collaborative

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