Open Access

REVIEW

Arterial Duct Stenting Versus Modified Blalock-Taussig Shunt in Patient with Ductal-Dependent Pulmonary Circulation: Systematic Review & Meta-Analysis

by Ketut Putu Yasa^1,2,*, Nyoman Satria Sadu Bhaskara², Putu Febry Krisna Pertiwi²

1 Department of Cardiothoracic & Vascular Surgery, Prof. Dr. I.G.N.G Ngoerah General Hospital, Denpasar, 80113, Indonesia
2 Faculty of Medicine, Udayana University, Denpasar, 80232, Indonesia

* Corresponding Author: Ketut Putu Yasa. Email:

Congenital Heart Disease 2024, 19(2), 139-156. https://doi.org/10.32604/chd.2024.050348

Received 03 February 2024; Accepted 08 April 2024; Issue published 16 May 2024

Abstract

Objective: Patients with ductal-dependent pulmonary circulation require alternative blood flow to provide and maintain adequate oxygenation. Modified Blalock-Taussig Shunt (MBTS) has been the standard for providing such a result. Currently, less invasive methods such as Arterial Duct (AD) stenting have been performed as alternatives. This study aims to compare the outcome of AD stenting and MBTS. Method: Systematic research was performed in online databases using the PRISMA protocol. The outcomes measured were 30-day mortality, complication, unplanned intervention, oxygen saturation, duration of hospital, and ICU length of stay. Any comparative study provided with full text is included. The outcome of each study was analyzed using a trandom effects model with relative risk and mean difference as the effect size. Bias risk assessment was conducted using the Newcastle-Ottawa Scale. All analyses were performed using Review Manager 5.4.1. Result: A total of 11 studies with 3154 samples included in this study. There is no significant difference in 30-day mortality between the two groups (p-value = 0.10). However, there is significantly less complication (RR 0.53 [0.35, 0.82]; p-value = 0.004) and unplanned intervention (RR 0.59 [0.38, 0.92]; p-value = 0.02) in the AD stent group. Comparison of the Nakata index showed no significant difference (p-value = 0.88). Post-operative oxygen saturation was measured significantly higher in the AD stenting (MD 1.80 [0.85, 2.74]; p-value = 0.0002). However, AD stent group shows significantly lower long-term oxygen saturation (MD −8.43 [−14.38, −2.48]; p-value = 0.005). Both hospital and ICU length of stay was significantly shorter in the AD stent group (MD −8.30 [−11.13, −5.48]; p-value < 0.00001; MD −5.09 [−7.79, −2.38]; p-value = 0.0002). Conclusion: AD stenting provides comparable outcomes relative to MBTS as it provides less complication and unplanned intervention and higher post-procedural O saturation. However, MBTS proved its superiority in maintaining higher long-term oxygen saturation and still became the preferred option to manage complex cases where stenting is either challenging or unsuccessful.

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Keywords

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