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

Stenting of the Patent Ductus Arteriosus: A Meta-analysis and Literature Review

“…In infants in whom the PDA is the only source of PBF, ductal spasm during the stenting procedure can quickly become a surgical emergency because all blood flow to the lungs ceases. 29 For this reason, single-source PBF is considered a contraindication to PDA stenting by some centers, which is reflected in our meta-analysis that found that a surgical shunt was more commonly employed in patients with single-source PBF. However, Bauser-Heaton et al 29 found that among patients with single-source PBF, PDA stenting was associated with procedural complication rates and mortality that were similar to those of surgical shunt procedure, suggesting that the rarity of ductal spasm still makes stenting an attractive alternative for these patients.…”

“…29 For this reason, single-source PBF is considered a contraindication to PDA stenting by some centers, which is reflected in our meta-analysis that found that a surgical shunt was more commonly employed in patients with single-source PBF. However, Bauser-Heaton et al 29 found that among patients with single-source PBF, PDA stenting was associated with procedural complication rates and mortality that were similar to those of surgical shunt procedure, suggesting that the rarity of ductal spasm still makes stenting an attractive alternative for these patients. However, in that setting, PDA stenting should be considered a relatively high-risk procedure that requires awareness of the cardiac intensive care team and, in some centers, >1 experienced operator and readiness to deploy surgical back up.…”

“…Multiple studies have shown similar or even superior rates of pulmonary artery growth among infants receiving PDA stents compared with those receiving surgical shunts. [9][10][11]13,[16][17][18]21,24,27 Even among patients with sole-source ductal-dependent PBF 29,54 and hypoplastic pulmonary arteries, 55 PDA stenting provides adequate pulmonary artery growth for definitive surgery. Because the PDA stent allows blood flow to enter the pulmonary arteries centrally (unlike surgical shunts, which are generally placed into one of the branches), it also appears to promote more symmetrical growth.…”

“…13,18,24 We included a small meta-analysis from available studies that supports pulmonary artery growth in PDA stenting, although its findings were not significant (Figure 7). 24,27,29,56…”

“…The most commonly reported acute complication is vessel occlusion or injury related to vascular access, which can generally be managed with heparin infusion. 6,8,13,18,24,27,29 Vascular access can also occasionally result in local infection. 6,57 Acute stent thrombosis is a rare (2%-3%) but life-threatening complication and usually presents as a precipitous drop in oxygen saturation in the minutes or hours following stent placement.…”