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Stent or Shunt, What Could be Better for Children with Duct Dependent Pulmonary Circulation?

Ghassan A Shaath1,2, Abdulraouf Mz Jijeh1,2, Mohammed Fararjeh1,2

  • 1Department of Cardiac Sciences, King Abdulaziz Cardiac Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.

Journal of the Saudi Heart Association
|January 27, 2022
PubMed

Insights

Systemic to pulmonary shunt and PDA stent offer alternatives for duct-dependent pulmonary circulation. PDA stents reduce ICU stay but increase thrombosis risk, while both methods support pulmonary artery growth and survival.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease
  • Interventional Cardiology

Background:

  • Systemic to pulmonary shunt (Shunt) is a common palliation for duct-dependent pulmonary circulation in children.
  • Patent ductus arteriosus (PDA) stent (Stent) is an emerging alternative for augmenting pulmonary blood flow.
  • Comparing outcomes between Shunt and Stent procedures is crucial for optimizing pediatric cardiac care.

Purpose of the Study:

  • To compare post-intervention outcomes in children undergoing either a systemic to pulmonary shunt or a PDA stent.
  • To evaluate the efficacy and safety of PDA stenting as an alternative to traditional shunting procedures.
  • To analyze differences in intensive care unit (ICU) stay, ventilation, thrombotic events, and long-term growth.

Main Methods:

  • Retrospective review of infants under 3 months who received either a Shunt or Stent between 2008 and 2016.
  • Follow-up until the second intervention or 1 year, whichever occurred earlier.
  • Comparison of clinical outcomes including ICU stay, ventilation days, thrombotic events, pulmonary artery growth, readmissions, and survival.

Main Results:

  • 187 patients (110 Shunt, 77 Stent) were analyzed; initial characteristics were similar.
  • Stent group had significantly shorter ICU stays (4 vs. 13 days) and ventilation days (1 vs. 5.5 days).
  • Stent group experienced more thrombotic events, while both groups showed comparable pulmonary artery growth, somatic growth, and survival rates, with a trend towards lower mortality in the Stent group.

Conclusions:

  • PDA stent implantation leads to a smoother ICU course and shorter hospital stay but carries a higher risk of vascular injury.
  • Both Shunt and Stent procedures demonstrate favorable outcomes for pulmonary artery growth, somatic growth, and patient survival.
  • The choice between Shunt and Stent should consider the trade-off between reduced ICU morbidity and increased thrombotic risk.
Abstract

Keywords:
Patent ductus arteriosusPulmonary artery growthShuntStent

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