Sirisani Joyce Darshinee, Haranal Maruti, Soo Kok Wai, Sivalingam Sivakumar, Mohd Khalid Khairul Faizah
Pediatric and Congenital Heart Centre, National Heart Institute, 145 Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia.
Department of Cardiothoracic and Vascular Surgery, National Heart Institute, 145 Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia.
Pediatr Cardiol. 2024 Jul 29. doi: 10.1007/s00246-024-03591-w.
Patent Ductus Arteriosus (PDA) stenting is an alternative to Modified Blalock-Taussig-Thomas Shunt (BT) to increase pulmonary blood flow in ductal-dependent pulmonary circulation. The objective of this study is to compare the immediate Intensive Care Unit (ICU) outcomes of PDA stent versus BT shunt in infants with ductal-dependent pulmonary circulation. This is a single center, retrospective study in infants less than 6 months with ductal-dependent pulmonary circulation palliated with either PDA stenting or BT shunt from January 2015 till December 2023. Data were reviewed from pediatric ICU database. Demographics details, ICU parameters, mortality and morbidity were compared. The propensity score with inverse probability weighting was used to control the effect of covariates. A total of 302 patients with PDA stenting and 100 patients with BT shunt were included. Majority of the patients had intervention at first month of life. 126 (41.7%) patient underwent PDA stenting while 36 (36%) had BTS. The PDA stenting group has shorter ICU stay, 3 (2.0,6.0) days versus 8 (4.8,13.0) days (p < 0.001), shorter length of hospital stay, 9 (6.8,15.0) days versus 16 (11.0,22.0) days (p < 0.001), shorter ventilation days, 2 (1.0,4.0) days versus 3 (2.0,7.0) days (p < 0.001) and lower mortality, 7 (2.3%) versus 16 (16.0%) (p < 0.001). At 3 months follow-up, the survival was higher in the PDA stenting group (p < 0.001). Conclusion: PDA stenting in infants with ductal-dependent pulmonary blood flow has a more favorable intensive care outcomes with shorter ICU and hospital stay. PDA stenting has a better survival outcome.
动脉导管未闭（PDA）支架置入术是改良布莱洛克 - 陶西格 - 托马斯分流术（BT）的替代方法，用于增加依赖导管的肺循环中的肺血流量。本研究的目的是比较PDA支架置入术与BT分流术对依赖导管的肺循环婴儿的重症监护病房（ICU）即刻结局。这是一项单中心回顾性研究，研究对象为2015年1月至2023年12月期间年龄小于6个月、依赖导管的肺循环采用PDA支架置入术或BT分流术进行姑息治疗的婴儿。数据来自儿科ICU数据库。比较了人口统计学细节、ICU参数、死亡率和发病率。采用倾向得分逆概率加权法来控制协变量的影响。共纳入302例接受PDA支架置入术的患者和100例接受BT分流术的患者。大多数患者在出生后第一个月接受了干预。126例（41.7%）患者接受了PDA支架置入术，而36例（36%）接受了BT分流术。PDA支架置入术组的ICU住院时间更短，分别为3（2.0，6.0）天和8（4.8，13.0）天（p＜0.001）；住院时间更短，分别为9（6.8，15.0）天和16（11.0，22.0）天（p＜0.001）；通气天数更短，分别为2（1.0，4.0）天和3（2.0，7.0）天（p＜0.001）；死亡率更低，分别为7例（2.3%）和16例（16.0%）（p＜0.001）。在3个月随访时，PDA支架置入术组的生存率更高（p＜0.001）。结论：对于依赖导管的肺血流婴儿，PDA支架置入术具有更有利的重症监护结局，ICU和住院时间更短。PDA支架置入术具有更好的生存结局。
