P47 Modified blalock-taussig shunts versus ductal stenting in duct dependent cyanotic congenital heart defects

Abstract

Objective To compare early post procedure outcomes, angiographic and intervention findings and 30 day survival between two groups of infants with duct dependent congenital heart disease; palliation with a Blalock-Taussig Shunt (mBTS) or with a ductal stent (DS). Ductal stenting is an emerging catheter therapy obviating the need for neonatal surgery and allowing palliation through to reparative surgery or subsequent cavo-pulmonary palliation later in infancy. Methods This retrospective cohort study was performed between July 2012 and July 2015. 39 patients underwent palliation during this period. 25 received a mBTS and 14 underwent ductal stent placement. Primary and secondary outcomes were survival and need for cardiac re-intervention up to reparative or subsequent palliative surgery. Results There was no difference in 30 day or one year survival between the two groups (30-day, 100% mBTS vs. 93% DS, p = 0.34; 1 year, 96% mBTS vs. 86% DS, p = 0.23). Re-intervention rates with need for a further mBTS, angioplasty+/- re-stent prior to reparative repair or cavo-pulmonary palliation was also similar between the groups (16% mBTS vs. 21% DS, p = 0.67). Pulmonary artery dimensions prior to subsequent surgery showed a non significant higher Nakata Index in the mBTS group compared to the DS group, (mean Nakata Index (Cl), mBTS 275 (210–342) vs 203 (152–253) P = 00.141). Oxygen saturations and haemoglobin level were similar across both groups. There was a similar need for pulmonary artery reconstruction at the time of subsequent surgery for both groups. There was a non-significant trend to earlier repair for the DS group (328 days mBTS vs. 234 days DS). Conclusions DS is a viable alternative to placing a mBTS for neonatal palliation of cyanotic congenital heart disease achieving similar outcomes. There remains concern about the longevity of DS with a need for earlier subsequent surgery and very close follow-up.