Ductal stenting vs. surgical shunting in late presenting duct-dependent pulmonary circulation: a single-center
Radityo Prakoso1, Christine Nathalina Sinaga Simanjorang2, Yovi Kurniawati1
1Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia.
Insights
Patent ductus arteriosus (PDA) stenting is a viable alternative to modified Blalock-Taussig (mBTT) shunts for late-presenting patients with congenital heart disease. This palliative approach shows comparable outcomes and reduced intensive care unit stays.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Patent ductus arteriosus (PDA) stenting is an established palliative approach for younger patients with duct-dependent congenital heart disease (CHD).
- Limited data exists on its efficacy in late presenters, particularly those aged over 30 days and under 5 years.
Purpose of the Study:
- To evaluate the clinical outcomes and intra-hospital costs of PDA stenting compared to modified Blalock-Taussig (mBTT) shunts in late-presenting patients with duct-dependent CHD.
Main Methods:
- A retrospective cohort study was conducted from August 2016 to August 2022.
- Included patients with duct-dependent CHD requiring palliative therapy.
- Compared outcomes, complications, and length of stay between PDA stenting and mBTT shunt groups.
Main Results:
- A total of 143 patients (43 PDA stent, 100 mBTT shunt) were analyzed.
- No significant difference in the composite outcome of 30-day mortality, reintervention, or rehospitalization between groups.
- PDA stenting group showed a significantly shorter ICU length of stay (2 days vs. 4 days, p=0.002).
Conclusions:
- PDA stenting is non-inferior to mBTT shunt for composite outcomes in late-presenting duct-dependent CHD.
- PDA stenting offers a significant reduction in intensive care unit length of stay.
Introduction:
PDA stenting is an option to mBTT shunt for younger patients; nevertheless, few reports of this palliative approach have been made for the late presenter population, especially for patients who are older than 30 days but under 5 years. This study aimed to evaluate the clinical result and intra-hospital costs of ductal stenting in late-presenting patients in comparison to surgical shunting.
Methods:
A single-center, retrospective cohort study was conducted from August 2016 to August 2022. This study included patients with pulmonary duct dependent CHD who were hospitalized for palliative therapy. The extracted data were baseline characteristics, clinical findings, supportive examination findings, complications, outcomes, and length of stay of the patients. Monitoring was carried out during treatment up to 30 days after the procedure.
Results:
A total of 143 patients were included in the analysis; 43 patients underwent PDA stent and 100 patients underwent mBTT shunt with median age of PDA stent group 110 (31-1,498) days and mBTT shunt group 174.5 (30-1,651) days. Primary outcome composite was not significant in both groups including 30 days mortality [6 (14%) vs. 14 (14%), p = 1.000], reintervention [1 (2.3%) vs. 7 (7%), p = 0.436], and 30 days rehospitalization [0 (0%) vs. 2 (2%), p = 0.319]. Secondary outcome analysis showed shorter ICU length of stay in the PDA stent group [2 (0-16) days vs. 4 (1-63) days, p = 0.002].
Conclusions:
PDA stent has an outcome that is non inferior from the mBTT shunt procedure in the composite outcome including 30 days mortality, reintervention, and 30 days rehospitalization but significantly lower in ICU length of stay.
