Prakoso Radityo, Citra Dewi Resi, Mendel Brian, Atmadikoesoemah Celly Anantaria, Purba Salomo, Sakti Damba Dwisepto Aulia, Iryuza Nanda, Kurniawati Yovi, Sukmawan Renan
Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia.
Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia.
Front Cardiovasc Med. 2024 Oct 24;11:1395132. doi: 10.3389/fcvm.2024.1395132. eCollection 2024.
Right ventricular outflow tract (RVOT) stenting as an alternative palliation for patients with stenotic RVOTs is increasingly recognized. However, a notable gap remains in the literature regarding the efficacy and the comparative outcomes between RVOT stenting and the modified Blalock-Taussig shunt (mBTS) in children older than one year.
We conducted a retrospective review of clinical data from patients aged one year to 18 years with stenotic RVOTs who underwent RVOT stenting or mBTS procedures at our institution between December 2019 and October 2022. We compared major adverse cardiovascular events (MACE) including re-hospitalization, re-intervention, and mortality, hospital and ICU length of stay, and discharge oxygen saturation between the groups.
We identified 58 patients (51.7% male) with a median age of 2.6 years (IQR: 2-8.1) and a median weight of 9.7 kg (IQR: 7.5-17.5). Among them, 18 (31%) patients received RVOT stenting, and 40 (68.9%) patients had mBTS. The median age for the RVOT stenting group was 92.5 months (IQR: 31.2-152) compared to 26.5 months (IQR: 23.0-54.0) for the mBTS group ( = 0.218). MACEs occurred in 4 (22.2%) patients with RVOT stents and 8 (20%) patients with mBTS ( = 0.624). Patients with mBTS had a longer ICU stay (median 3.5 days, IQR, 2-5) compared to those with RVOT stents (median 2 days, IQR: 1-2) ( = 0.295). Conversely, the hospital stay for patients with mBTS was shorter (median 10 days, IQR, 7.5-13.7) than for those with RVOT stents (median 11.5 days, IQR, 7-19) ( = 0.045). The median discharge oxygen saturation was 87% (IQR: 83-88) in the mBTS group and 80% (IQR: 75-87) in the RVOT stenting group ( = 0.212).
RVOT stenting as palliation to stenotic RVOTs in children older than one year demonstrated outcomes comparable to mBTS in terms of MACE and achieving oxygen saturation targets.
右心室流出道（RVOT）支架置入术作为狭窄性RVOT患者的一种替代姑息治疗方法，越来越受到认可。然而，关于1岁以上儿童RVOT支架置入术与改良布莱洛克-陶西格分流术（mBTS）的疗效及比较结果，文献中仍存在显著空白。
我们对2019年12月至2022年10月期间在本机构接受RVOT支架置入术或mBTS手术的1岁至18岁狭窄性RVOT患者的临床资料进行了回顾性分析。我们比较了两组之间的主要不良心血管事件（MACE），包括再次住院、再次干预和死亡率、住院时间和重症监护病房（ICU）住院时间以及出院时的血氧饱和度。
我们确定了58例患者（51.7%为男性），中位年龄为2.6岁（四分位间距：2 - 8.1），中位体重为9.7 kg（四分位间距：7.5 - 17.5）。其中，18例（31%）患者接受了RVOT支架置入术，40例（68.9%）患者进行了mBTS。RVOT支架置入术组的中位年龄为92.5个月（四分位间距：31.2 - 152），而mBTS组为26.5个月（四分位间距：23.0 - 54.0）（P = 0.218）。4例（22.2%）接受RVOT支架置入术的患者和8例（20%）接受mBTS的患者发生了MACE（P = 0.624）。与接受RVOT支架置入术的患者（中位2天，四分位间距：1 - 2）相比，接受mBTS的患者ICU住院时间更长（中位3.5天，四分位间距：2 - 5）（P = 0.295）。相反，接受mBTS的患者住院时间比接受RVOT支架置入术的患者短（中位10天，四分位间距：7.5 - 13.7）（中位11.5天，四分位间距：7 - 19）（P = 0.045）。mBTS组出院时的中位血氧饱和度为87%（四分位间距：83 - 88），RVOT支架置入术组为80%（四分位间距：75 - 87）（P = 0.212）。
对于1岁以上儿童的狭窄性RVOT，RVOT支架置入术作为姑息治疗在MACE和实现血氧饱和度目标方面的结果与mBTS相当。
