Is arterial ductal stent as effective as surgical shunt for palliation in staged repair of tetralogy of Fallot with pulmonary stenosis?

TL;DR

This study compares two palliative treatments for a heart defect and finds they are similarly effective in preparing for later surgery.

Contribution

The study provides new evidence comparing arterial ductal stent and surgical shunt effectiveness in promoting pulmonary annulus growth.

Findings

Both arterial ductal stent and surgical shunt promote similar growth of pulmonary annulus and arteries.

Valve-sparing repair rates were comparable between the two groups.

ADS resulted in shorter hospital stays without increasing reintervention or mortality risks.

Abstract

A staged repair strategy in the form of Modified Blalock-Taussig-Thomas shunt has been performed to facilitate the growth of pulmonary valve annulus, so that patients with marginally small annulus could benefit from pulmonary valve-sparing repair. However, little has been reported on the influence of arterial ductal stent (ADS) on the growth of pulmonary annulus and pulmonary artery, with subsequent valve-sparing repair.

Patients who underwent staged repair of tetralogy of Fallot with Pulmonary Stenosis with either ADS or surgical shunt were included. Echocardiographic and angiographic measurements of pulmonary annulus and pulmonary artery prior to initial palliation and complete repair were recorded.

A total of 110 patients were included, 44 (40%) patients underwent ADS and 66 (60%) patients had surgical shunt. Pulmonary annulus and pulmonary arteries grew significantly following palliation with both ADS (P = 0.011) and surgical shunt (P < 0.01), with a similar rate of increment (P = 0.205). There was no significant difference in the rate of valve-sparing repair between the 2 groups (MBTTS, 62.1% vs ADS, 47.7%, P = 0.149). However, patients who underwent ADS had shorter stays in hospital (P = 0.048). Reintervention rate and mortality rate in the interstage period were similar in both groups (P = 0.229 and P = 0.210, respectively). There was no reintervention in patients who successfully underwent valve-sparing repair following both palliation groups in the follow-up period.

ADS is as effective as surgical shunt as a palliative procedure in promoting the growth of pulmonary annulus and pulmonary arteries, with comparable rate of valve-sparing repair during corrective surgery.

Although the history of tetralogy of Fallot with pulmonary stenosis (TOF-PS) repair extends over 6 decades, the optimal surgical strategy of corrective surgery has remained controversial and is still under debate.

Figures