Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
J Thorac Cardiovasc Surg. 2014 Jan;147(1):397-401. doi: 10.1016/j.jtcvs.2013.07.052. Epub 2013 Sep 23.

Modified Blalock-Taussig shunt versus ductal stenting for palliation of cardiac lesions with inadequate pulmonary blood flow.

Author information

  • 1Division of Pediatric Cardiac Surgery, Seattle Children's Hospital, Seattle, Wash. Electronic address: michael.mcmullan@seattlechildrens.org.
  • 2Division of Pediatric Cardiac Surgery, Seattle Children's Hospital, Seattle, Wash.
  • 3Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Wash.

Abstract

OBJECTIVE:

The modified Blalock-Taussig shunt is the most commonly used palliative procedure for infants with ductal-dependent pulmonary circulation. Recently, catheter-based stenting of the ductus arteriosus has been used by some centers to avoid surgical shunt placement. We evaluated the durability and safety of ductal stenting as an alternative to the modified Blalock-Taussig shunt.

METHODS:

A single-institution, retrospective review of patients undergoing modified Blalock-Taussig shunt versus ductal stenting was performed. Survival, procedural complications, and freedom from reintervention were the primary outcome variables.

RESULTS:

A total of 42 shunted and 13 stented patients with similar age and weight were identified. Survival to second-stage palliation, definitive repair, or 12 months was similar between the 2 groups (88% vs 85%; P = .742). The incidence of surgical or catheter-based reintervention to maintain adequate pulmonary blood flow was 26% in the shunted patients and 25% in the stented patients (P = 1.000). Three shunted patients (7%) required intervention to address contralateral pulmonary artery stenosis and 3 (7%) required surgical reintervention to address nonpulmonary blood flow-related complications. The need for ipsilateral or juxtaductal pulmonary artery intervention at, or subsequent to, second-stage palliation or definitive repair was similar between the 2 groups.

CONCLUSIONS:

Freedom from reintervention to maintain adequate pulmonary blood flow was similar between infants undergoing modified Blalock-Taussig shunt or ductal stenting as an initial palliative procedure. However, a greater percentage of shunted patients experienced procedure-related complications and distal branch pulmonary artery stenosis. Palliative ductal stenting appears to be a safe and effective alternative to modified Blalock-Taussig in selected infants.

Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

KEYWORDS:

20; 28; DS; STS; Society of Thoracic Surgeons; ductal stenting; mBTS; modified Blalock-Taussig systemic-to-pulmonary shunt

Comment in

  • Discussion. [J Thorac Cardiovasc Surg. 2014]
PMID:
24071469
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk