Abstract
BackgroundBoth systemic-pulmonary shunt and arterial duct stent could be the palliation of duct-dependent pulmonary circulation. We aimed to compare the safety and efficacy of the two approaches.MethodsThe PubMed, EMBASE, and Cochrane Library databases were searched through December 2019 for studies comparing stent implantation and surgical shunt in duct-dependent pulmonary circulation. The baseline characteristics included ventricle physiology and cardiac anomaly. The main outcomes were hospital stay and total mortality. Additional outcomes included procedural complications, intensive care unit (ICU) stay, pulmonary artery growth at follow-up, and other indexes. A random- or fixed-effects model was used to summarize the estimates of the mean difference (MD)/risk ratio (RR) with 95% confidence intervals (CIs).ResultsIn total, 757 patients with duct-dependent pulmonary circulation from six studies were included. Pooled estimates of hospital stay (MD, − 4.83; 95% CI − 7.92 to − 1.74; p < 0.05), total mortality (RR 0.44; 95% CI 0.28–0.70; p < 0.05), complications (RR 0.49; 95% CI 0.30–0.81; p < 0.05) and ICU stay (MD, − 4.00; 95% CI − 5.96 to − 2.04; p < 0.05) favored the stent group. Significant differences were found in the proportions of patients with a single ventricle (RR 0.82; 95% CI 0.68–0.98; p < 0.05) or a double ventricle (RR 1.23; 95% CI 1.07–1.41; p < 0.05) between the stent and shunt groups. Additionally, pulmonary artery growth showed no significant differences between the two groups.ConclusionArterial duct stent appears to have not inferior outcomes of procedural complications, mortality, hospital and ICU stay, and pulmonary artery growth in selected patients compared with a surgical shunt.Trial registrationCRD42019147672.
Highlights
In young patients with diminished pulmonary blood flow, a patent ductus arteriosus (PDA) is needed to maintain stable hemodynamics
A total of 85 patients had a single ventricle and 130 patients had a double ventricle in the stent group, and 231 patients had a single ventricle and 238 patients had a double ventricle in the shunt group
We found that the proportion of patients with a single ventricle (RR 0.82; 95% Confidence interval (CI) 0.68–0.98; p < 0.05) was lower, but the proportion of patients with a double ventricle (RR 1.23; 95% CI 1.07– 1.41; p < 0.05) was higher in the stent group than the shunt group (Table 2 and Additional file 2)
Summary
In young patients with diminished pulmonary blood flow, a patent ductus arteriosus (PDA) is needed to maintain stable hemodynamics Such a condition often occurs in neonates with complex congenital heart disease whose hemodynamic stability depends on a PDA. Despite its widespread use and technical improvements, surgical shunt has been reported to be associated with significant mortality and morbidity [6, 7]. Both systemic-pulmonary shunt and arterial duct stent could be the palliation of duct-dependent pulmonary circulation. We aimed to compare the safety and efficacy of the two approaches
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