Mini Nathalie, Schneider Martin B E, Asfour Boulos, Mikus Marian, Zartner Peter A
Department of Cardiology, German Pediatric Heart Center, University Hospital of Bonn, Bonn, Germany.
Department of Pediatric Cardiac Surgery, German Pediatric Heart Center, University Hospital of Bonn, Bonn, Germany.
Front Cardiovasc Med. 2022 Jun 23;9:933959. doi: 10.3389/fcvm.2022.933959. eCollection 2022.
As no data were available on the comparison of outcomes between modified Blalock-Taussig shunts (MBTs) vs. duct-stenting (DS) in patients with pulmonary atresia (PA) and an increased ductal tortuosity and in patients with pulmonary atresia and intact septum (PA-IVS) with right ventricle-dependent coronary circulation (RVDCC), we aimed to perform a single-center retrospective evaluation.
Between 2010 and 2019, 127 patients with duct-dependent pulmonary circulation (DDPC) underwent either MBTs (without additional repairs) ( = 56) or DS ( = 71). The primary endpoint was defined as arriving at the next planned surgery (Glenn or biventricular repair) avoiding one of the following: (1) unplanned surgery or unplanned perforation of the pulmonary valve (PVP) with a stent, (2) procedure-related permanent complications, and (3) death. Two subgroups were considered: (1) patients who had a ductal curvature index (DCI) >0.45 ( = 32) and (2) patients with PA-IVS and RVDCC ( = 13). Ductal curvature index (DCI) was measured in all the patients to assess the tortuosity of the ducts. Patients with DCI >0.45 were considered as being in a high-risk group for the duct-stenting; a previous study showed that the patients with a DCI < 0.45 had a better outcome when compared with those with a DCI> 0.45.
The primary outcome was achieved equally in the two groups (77.5% in DS, 75% in MBTs). Hospital deaths, need for ECMO, and the occurrence of major complications was more frequent in the group with MBTs with an Odds Ratio (OR) of 5, 0.8, and 4, respectively, and a 95% Confidence Interval () 1.1-22.6, 0.7-0.9, and 1.6-10.3, respectively, and a -value < 0.05. For the two subgroups, the primary outcome was achieved in 64% of patients with a DCI >0.45 who received MBTs compared to 20% in those with DS (OR 3.5, 95% 1.2-10, 0.005). While 74.1% of the patients with PA-IVS and RVDCC after DS had achieved the primary outcome, all patients with MBTs had an impaired outcome (OR 3.5, 95% 1-11.2, 0.004).
MBTs showed a better outcome in patients with tortuous ducts compared to DS. DS seems to be superior in patients with DDPC with DCI <0.45 and patients with PA-IVS with RVDCC.
对于肺动脉闭锁（PA）且动脉导管迂曲增加的患者以及伴有右心室依赖性冠状动脉循环（RVDCC）的肺动脉闭锁合并完整室间隔（PA-IVS）患者，目前尚无关于改良布莱洛克 - 陶西格分流术（MBT）与动脉导管支架置入术（DS）疗效比较的数据，因此我们旨在进行一项单中心回顾性评估。
2010年至2019年间，127例依赖动脉导管的肺循环（DDPC）患者接受了MBT（无额外修复）（n = 56）或DS（n = 71）治疗。主要终点定义为成功进行下一次计划手术（格林手术或双心室修复），同时避免以下情况之一：（1）计划外手术或带支架的肺动脉瓣（PVP）意外穿孔；（2）与手术相关的永久性并发症；（3）死亡。研究考虑了两个亚组：（1）动脉导管曲率指数（DCI）>0.45的患者（n = 32）；（2）PA-IVS和RVDCC患者（n = 13）。对所有患者测量动脉导管曲率指数（DCI）以评估动脉导管的迂曲程度。DCI>0.45的患者被视为动脉导管支架置入的高危组；先前的一项研究表明，与DCI>0.45的患者相比，DCI<0.45的患者预后更好。
两组患者达到主要结局的情况相同（DS组为77.5%，MBT组为75%）。MBT组的医院死亡、需要体外膜肺氧合（ECMO）以及发生主要并发症的情况更为频繁，优势比（OR）分别为5、0.8和4，95%置信区间（CI）分别为1.1 - 22.6、0.7 - 0.9和1.6 - 10.3，P值<0.05。对于两个亚组，DCI>0.45且接受MBT治疗的患者中64%达到了主要结局，而接受DS治疗的患者中这一比例为20%（OR 3.5，95% CI 1.2 - 10，P = 0.005）。在接受DS治疗后，PA-IVS和RVDCC患者中有74.1%达到了主要结局，而所有接受MBT治疗的患者结局均不佳（OR 3.5，95% CI 1 - 11.2，P = 0.004）。
与DS相比，MBT在动脉导管迂曲的患者中显示出更好的结局。DS似乎在DCI<0.45的DDPC患者以及PA-IVS和RVDCC患者中更具优势。
