Hostname: page-component-77c89778f8-gvh9x Total loading time: 0 Render date: 2024-07-19T14:42:29.606Z Has data issue: false hasContentIssue false
  • English
  • Français

Haemodynamic and clinical variables after surgical systemic to pulmonary artery shunt placement versus arterial ductal stenting

Published online by Cambridge University Press:  15 December 2022

Saloni P. Sheth Open the ORCID record for Saloni P. Sheth [Opens in a new window]  and
Rohit S. Loomba Open the ORCID record for Rohit S. Loomba [Opens in a new window]
Saloni P. Sheth*
Affiliation:
Division of Pediatric Cardiology, Advocate Children’s Hospital, Oak Lawn, IL, USA
Rohit S. Loomba
Affiliation:
Division of Pediatric Cardiology, Advocate Children’s Hospital, Oak Lawn, IL, USA
*
Author for correspondence: Saloni P. Sheth, Division of Pediatric Cardiology, Advocate Children’s Hospital, Oak Lawn, IL, USA. E-mail: Saloni.Sheth@aah.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Transcatheter stenting of the arterial duct is an alternative to surgical systemic to pulmonary artery shunt in neonates with parallel circulation. The current study compares haemodynamic and laboratory values in these patients for the first 48 hours after either intervention.

Methods:

Neonates with ductal dependent pulmonary blood flow who underwent surgical shunt placement or catheter-based arterial ductal stent placement between January 2013 and January 2022 were identified. Haemodynamic variables included heart rate, blood pressure, near infrared spectroscopy, central venous pressure, vasoactive inotropic score, and arterial saturation. Laboratory variables collected included blood urea nitrogen, serum creatinine, and serum lactate. Variables were collected at baseline, upon post-procedural admission, 6 hours after admission, 12 hours after admission, and 48 hours after admission. Secondary outcomes included post-procedural mechanical ventilation duration, post-procedural hospital length of stay, need for reintervention, need for extracorporeal membrane oxygenation, cardiac arrest, and inpatient mortality.

Results:

Of the 52 patients included, 38 (73%) underwent shunt placement while 14 (27%) underwent a stent placement. Heart rates, renal oxygen extraction ratio, and cerebral oxygen extraction ratio were significantly lower in the stent group (p = <0.01, 0.01, and < 0.01, respectively).

Haemoglobin and vasoactive inotropic scores were significantly lower in the stent group (p = <0.01, <0.01, respectively). The stent group had increased risk for cardiac arrest (p = 0.04).

Conclusion:

Patients who undergo arterial ductal stent placement have lower heart rates, haemoglobin, renal oxygen extraction ratio, cerebral oxygen extraction ratio, and vasoactive inotropic score in the first 48 hours post-procedure compared to patients with shunt placement.

Keywords

Arterial ductal stentmodified Blalock–Taussig–Thomas shunthaemodynamic variables
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 10 , October 2023 , pp. 2060 - 2065
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fakhry AbdelMassih, A, Menshawey, R, Menshawey, E, et al. Blalock-taussig shunt versus ductal stent in the palliation of duct dependent pulmonary circulation; a systematic review and metanalysis. Curr Probl Cardiol 2021; 47: 100885.10.1016/j.cpcardiol.2021.100885CrossRefGoogle ScholarPubMed
Bauser-Heaton, H, Qureshi, AM, Goldstein, BH, et al. Comparison of patent ductus arteriosus stent and blalock-taussig shunt as palliation for neonates with sole source ductal-dependent pulmonary blood flow: results from the congenital catheterization research collaborative. Pediatr Cardiol 2022; 43: 121–131.10.1007/s00246-021-02699-7CrossRefGoogle ScholarPubMed
Gaies, MG, Gurney, JG, Yen, AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234–238.10.1097/PCC.0b013e3181b806fcCrossRefGoogle ScholarPubMed
Gibbs, JL, Rothman, MT, Rees, MR, Parsons, JM, Blackburn, ME, Ruiz, CE. Stenting of the arterial duct: a new approach to palliation for pulmonary atresia. Br Heart J 1992; 67: 240–245.10.1136/hrt.67.3.240CrossRefGoogle ScholarPubMed
Gibbs, JL, Uzun, O, Blackburn, ME, Wren, C, Hamilton, JR, Watterson, KG. Fate of the stented arterial duct. Circulation 1999; 99: 2621–2625.10.1161/01.CIR.99.20.2621CrossRefGoogle ScholarPubMed
Gewillig, M, Boshoff, DE, Dens, J, Mertens, L, Benson, LN. Stenting the neonatal arterial duct in duct-dependent pulmonary circulation: new techniques, better results. J Am Coll Cardiol 2004; 43: 107–112.10.1016/j.jacc.2003.08.029CrossRefGoogle ScholarPubMed
Bahaidarah, S, Al-Ata, J, Alkhushi, N, et al. Outcome of ductus arteriosus stenting including vertical tubular and convoluted tortuous ducts with emphasis on technical considerations. Egypt Heart J 2021; 73: 83.10.1186/s43044-021-00210-4CrossRefGoogle ScholarPubMed
Bentham, JR, Zava, NK, Harrison, WJ, et al. Duct stenting versus modified blalock-taussig shunt in neonates with duct-dependent pulmonary blood flow: associations with clinical outcomes in a multicenter national study. Circulation 2018; 137: 581–588.10.1161/CIRCULATIONAHA.117.028972CrossRefGoogle Scholar
Glatz, AC, Petit, CJ, Goldstein, BH, et al. Comparison between patent ductus arteriosus stent and modified blalock-taussig shunt as palliation for infants with ductal-dependent pulmonary blood flow: insights from the congenital catheterization research collaborative. Circulation 2018; 137: 589–601.10.1161/CIRCULATIONAHA.117.029987CrossRefGoogle ScholarPubMed
Goldstein, BH, O'Byrne, ML, Petit, CJ, et al. Differences in cost of care by palliation strategy for infants with ductal-dependent pulmonary blood flow. Circ Cardiovasc Interv 2019; 12: e007232.10.1161/CIRCINTERVENTIONS.118.007232CrossRefGoogle ScholarPubMed
Williams, JA, Bansal, AK, Kim, BJ, et al. Two thousand blalock-taussig shunts: a six-decade experience. Ann Thorac Surg 2007; 84: 2070–2075.10.1016/j.athoracsur.2007.06.067CrossRefGoogle ScholarPubMed
Petrucci, O, O'Brien, SM, Jacobs, ML, Jacobs, JP, Manning, PB, Eghtesady, P. Risk factors for mortality and morbidity after the neonatal blalock-taussig shunt procedure. Ann Thorac Surg 2011; 92: 642–651.10.1016/j.athoracsur.2011.02.030CrossRefGoogle ScholarPubMed
Bronicki, RA, Hall, M. Cardiopulmonary bypass-induced inflammatory response: pathophysiology and treatment. Pediatr Crit Care Med 2016; 17: S272–278.10.1097/PCC.0000000000000759CrossRefGoogle ScholarPubMed
Epting, CL, McBride, ME, Wald, EL, Costello, JM. Pathophysiology of post-operative low cardiac output syndrome. Curr Vasc Pharmacol 2016; 14: 14–23.10.2174/1570161113666151014123718CrossRefGoogle ScholarPubMed
Qureshi, AM, Goldstein, BH, Glatz, AC, et al. Classification scheme for ductal morphology in cyanotic patients with ductal dependent pulmonary blood flow and association with outcomes of patent ductus arteriosus stenting. Catheter Cardiovasc Interv 2019; 93: 933–943.10.1002/ccd.28125CrossRefGoogle ScholarPubMed