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Surgical versus transcatheter palliation for insufficient pulmonary blood supply in infants with cyanotic CHD

Part of: Tetralogy of Fallot (TOF) Surgery Interventional Cardiology

Published online by Cambridge University Press:  24 May 2021

Andrew B. Ho Open the ORCID record for Andrew B. Ho [Opens in a new window] ,
Thomas Perry ,
Ines Hribernik ,
John D. Thomson  and
James R. Bentham
Andrew B. Ho
Affiliation:
Congenital Cardiology, Leeds General Infirmary, Great George Street, Leeds, United Kingdom University Hospitals Southampton NHS Trust, Tremona Road, Southampton, United Kingdom
Thomas Perry
Affiliation:
Department of Biomedical Sciences, University of Plymouth, Plymouth, United Kingdom
Ines Hribernik
Affiliation:
Congenital Cardiology, Leeds General Infirmary, Great George Street, Leeds, United Kingdom
John D. Thomson
Affiliation:
Congenital Cardiology, Leeds General Infirmary, Great George Street, Leeds, United Kingdom
James R. Bentham*
Affiliation:
Congenital Cardiology, Leeds General Infirmary, Great George Street, Leeds, United Kingdom
*
Author for correspondence: Dr James Bentham, Congenital Cardiology, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, United Kingdom. Tel: +441132432799. E-mail: James.Bentham@nhs.net
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Abstract

Infants with complex cyanotic CHD can become symptomatic from insufficient pulmonary blood supply following either ductal closure or due to outflow tract obstruction. Blalock–Taussig shunt mortality remains significant and recent studies have highlighted the advantages of using transcatheter alternatives. We present here our experience in changing our primary choice of palliation from the Blalock–Taussig shunt to transcatheter palliation with either a ductal stent or, if antegrade flow is present, a right ventricular outflow tract stent.

This is a retrospective, single-unit cohort study. Eighty-seven infants underwent palliation for insufficient pulmonary blood flow at under 3 months of age between 2012 and 2019. On an intention-to-treat basis, 29 underwent insertion of a Blalock–Taussig shunt, 36 duct stents, and 22 right ventricular outflow tract stents at median ages of 15, 9, and 32 days, respectively, and median weights of 3.3, 3.1, and 3.1 kg, respectively. No primary Blalock–Taussig shunts have been performed in our institution since 2017.

At 30-days there had been one death in each group (univariable p = 0.93) and deaths prior to repair totalled three in the shunt group, four in the ductal stent group, and two in the right ventricular outflow tract stent group (univariable p = 0.93). Reintervention on the pulmonary circuit prior to next stage of surgery was more frequent in those undergoing transcatheter intervention, reaching statistical significance by logrank (p = 0.012).

In conclusion, within this work we provide further evidence of the safety and efficacy of transition from a primary surgical to primary transcatheter palliation pathway in infants with insufficient pulmonary blood supply.

Keywords

Blalock–Taussig shuntstenttetralogy of Fallotpulmonary atresiamortality
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 1 , January 2022 , pp. 42 - 47
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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