Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany.
Eur J Cardiothorac Surg. 2024 Mar 1;65(3). doi: 10.1093/ejcts/ezae011.
In this study, we aimed to compare infants with univentricular hearts who underwent an initial ductus stenting to those receiving a surgical systemic-to-pulmonary shunt (SPS).
All infants with univentricular heart and ductal-dependent pulmonary blood flow who underwent initial palliation with either a ductus stenting or a surgical SPS between 2009 and 2022 were reviewed. Outcomes were compared after ductus stenting or SPS including survival, probability of re-interventions and the probability to reach stage II palliations.
A total of 130 patients were evaluated, including 49 ductus stenting and 81 SPSs. The most frequent primary diagnosis was tricuspid atresia in 27, followed by pulmonary atresia with intact ventricular septum in 19 patients. There was comparable hospital mortality (2.0% stent vs 3.7% surgery, P = 0.91) between the groups, but shorter intensive care unit stay (median 1 vs 7 days, P < 0.01) and shorter hospital stay (median 7 vs 17 days, P < 0.01) were observed in patients with initial ductus stenting, compared to those with SPS. However, acute procedure-related complications were more frequently observed in patients with ductus stenting, compared with those with SPS (20.4 vs 6.2%, P = 0.01), and 10 patients needed a shunt procedure after the initial ductus stent. The cumulative incidence of reaching stage II was similar between ductus stenting and SPS (88.0 vs 90.6% at 12 months, P = 0.735). Pulmonary artery (PA) index (median 194 vs 219 mm2/m2, P = 0.93) at stage II was similar between patients with ductus stenting and SPS. However, the ratio of the left to the right PA index [0.69 (0.45-0.95) vs 0.86 (0.51-0.84), P = 0.015] was higher in patients who reached stage II with surgical shunt physiology, compared with patients with ductus stent physiology.
After initial ductus stenting in infants with univentricular heart, survival is comparable and post-procedural recovery shorter, but more acute stent dysfunctions and lower development of left PA are observed, compared to acute shunt dysfunctions. The less invasive procedure and shorter hospital stay are at the expense of more stent reinterventions.
本研究旨在比较行初始动脉导管支架置入术与接受外科体肺分流术（SPS）的单心室心脏婴儿的情况。
回顾了 2009 年至 2022 年间接受初始动脉导管支架置入术或外科 SPS 姑息治疗的所有单心室心脏伴导管依赖性肺血流的婴儿。在动脉导管支架置入术或 SPS 后，比较了包括存活率、再干预概率和达到 II 期姑息治疗概率在内的结局。
共评估了 130 例患者，其中 49 例行动脉导管支架置入术，81 例行 SPS。最常见的原发性诊断是三尖瓣闭锁，有 27 例，其次是肺动脉闭锁伴完整室间隔，有 19 例。两组的院内死亡率相当（支架 2.0%，手术 3.7%，P=0.91），但初始动脉导管支架置入术组的重症监护病房住院时间（中位数 1 天 vs 7 天，P<0.01）和住院时间（中位数 7 天 vs 17 天，P<0.01）更短。然而，与 SPS 组相比，动脉导管支架置入术组的急性手术相关并发症更常见（20.4% vs 6.2%，P=0.01），10 例患者在初始动脉导管支架置入后需要分流术。达到 II 期的累积发生率在动脉导管支架置入术和 SPS 之间相似（12 个月时分别为 88.0%和 90.6%，P=0.735）。在达到 II 期时，两组患者的肺动脉指数（PA 指数）（中位数 194 毫米 2/米 2 vs 219 毫米 2/米 2，P=0.93）相似。然而，与动脉导管支架生理学相比，具有外科分流生理学的患者达到 II 期时左肺动脉与右肺动脉指数的比值更高[0.69（0.45-0.95）比 0.86（0.51-0.84），P=0.015]。
在单心室心脏婴儿中进行初始动脉导管支架置入术后，与急性分流功能障碍相比，存活率相当，术后恢复更快，但观察到更多的急性支架功能障碍和较低的左肺动脉发育。这种微创治疗和较短的住院时间是以更多的支架再干预为代价的。
