Abstract
The aim of this study was to perform a systematic review and meta-analysis to evaluate the safety and efficacy of ductus arteriosus stent (DAS) compared with surgical systemic-pulmonary artery shunt (SPS) in patients with ductal-dependent pulmonary blood flow. A literature search was conducted in PubMed, Embase, and the Cochrane Library databases from their inception to December 2020. Two reviewers independently screened the articles, evaluated the quality of the articles, and collected the data. Meta-analyses were conducted using fixed and random effects models. We used the I-square (I2 ) test to examine heterogeneity and the funnel plot Egger’s test was used to test for publication bias. We analyzed nine studies including 842 patients were included in the present study (DAS: n = 295; SPS: n = 547). There was a benefit in favor of DAS group for medium-term mortality (RR, 0.63; 95% CI, [0.40, 0.99]; P = 0.91, I2 = 0%). DAS group demonstrated a reduced risk for complications compared with SPS (RR, 0.46; 95% CI, [0.29, 0.72]; P = 0.78, I2 = 0%). There was an increased risk for unplanned reintervention for DAS (RR, 1.77; 95% CI, [1.42, 2.20]; P = 0.61, I2 = 0%). DAS demonstrated shorter mean intensive care unit length of stay (MD, –5.12; 95% CI, [–7.33, –2.91]; P = 0.005, I2 = 76%). There was also demonstrated higher postprocedure oxygen saturation for SPS over DAS (MD, 1.78; 95% CI, [0.92, 2.64]; P = 0.46, I2 = 0%). There was no difference between the two groups in terms of mortality within 30 days, Nakata Index, and hospital length of stay. Conclusions: In terms of initial palliative surgical in the ductal-dependent pulmonary blood flow, DAS demonstrated a lower risk of medium-term mortality, lower risk of complications, higher risk of unplanned reintervention, shorter ICU length of stay, and higher postprocedure oxygen saturation compared with SPS.
Highlights
The rapid increase in the number of patients with congenital heart disease (CHD) is a serious medical care problem [1]
Patients in the 1-month mortality group were more likely to have selected ‘do not attempt resuscitation (DNAR)’ and less likely to have selected ‘full resuscitation’ than were those in the survival group (44.4% vs. 2.7%, P < 0.001, and 44.4% vs. 90.4%, P = 0.002, respectively)
4.1 Statement of Principal Findings This retrospective Japanese database study sought to clarify the actual condition of in-hospital patients with CHD who required rapid response systems (RRS) activation
Summary
The rapid increase in the number of patients with congenital heart disease (CHD) is a serious medical care problem [1]. The incidence of CHD is approximately 7–8 per 1,000 live births [2,3]. These patients exhibit improved survival because of advances in prenatal diagnosis, cardiac surgery, perioperative care, and lifelong healthcare systems; 85%–90% of patients with CHD in high-income countries survive into adulthood [4]. This increased survival rate has led to increased adult CHD-related hospitalizations and associated medical costs [5,6] and an elevated risk of in-hospital deterioration. The risk of clinical worsening is high in the perioperative period and after intensive care unit (ICU) discharge [9]
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