PDA stent better than APS for initial palliation in patients with congenital heart disease: JAHA

USA: In cyanotic congenital heart disease with ductal-dependent pulmonary blood flow, a patent ductus arteriosus (PDA) stent is associated with fewer complications and a shorter length of hospital stay than aortopulmonary shunt (APS). Also, there was a significant difference in mortality or unplanned reinterventions, states an article published in The Journal of the American Heart Association.

In patients with cyanotic congenital heart disease (CHD) and ductal‐dependent pulmonary blood flow (DDPBF) establishing a stable source of pulmonary blood flow using palliative techniques is crucial. Palliative techniques help to "buy time" until the subsequent definitive repair is performed and survival may depend on its design. Historically, this was achieved through a surgical aortopulmonary shunt (APS) but there was a significant risk of morbidity and mortality with this surgical procedure. Over the last decade, PDA stent has emerged as a viable alternative to APS. It is a less invasive approach and recovery is faster. Nevertheless, PDA stent also carries risks of procedural complications and increased need for reinterventions

Stephanie Y., Cincinnati Children's Hospital Medical Center, OH, USA, and her team conducted a meta‐analysis to compare mortality risk and clinical outcomes after the use of PDA stent and APS, as initial palliation in patients with ductal‐dependent pulmonary blood flow.

The research team performed a comprehensive search from PubMed and Embase databases which yielded six retrospective observational studies that met inclusion criteria. Pooled adjusted hazard ratios (HR) were included to control for covariates and assess time to event analysis. Of 757 patients, 243 (32.1%) underwent PDA stent and 514 (67.9%) underwent APS.

Key findings of the analysis:

• Pulmonary atresia with an intact ventricular septum and expected biventricular repair were more common with PDA stent compared with APS.

• There was no statistically significant difference in mortality between PDA stent and APS (HR, 0.71)

• PDA stent was associated with a lower risk of postprocedural complications, mechanical circulatory support, shorter length of ICU stay, and hospital stay), and duration of mechanical ventilation.

• There was no difference in pulmonary artery growth or hazard of unplanned reinterventions between PDA stent and APS

The authors conclude that PDA stent has a similar risk of mortality or unplanned reinterventions as APS. However, PDA has benefits including a shorter duration of mechanical ventilation support, shorter hospital and ICU LOS, and fewer procedural complications. The existing literature supports differences in patient characteristics with more patients with PA‐IVS and expected biventricular repair undergoing PDA stent.

PDA stent may be favorable to surgical APS due to its multiple benefits in postintervention care, though have similar mortality and reintervention rates. Further RCTs are needed to determine which strategy is superior in different types of CHD with ductal‐dependent pulmonary blood flow, the authors wrote.

Reference:

Tseng SY, Truong VT, Peck D, Kandi S, Brayer S, Jason DP 3rd, Mazur W, Hill GD, Ashfaq A, Goldstein BH, Alsaied T. Patent Ductus Arteriosus Stent Versus Surgical Aortopulmonary Shunt for Initial Palliation of Cyanotic Congenital Heart Disease with Ductal-Dependent Pulmonary Blood Flow: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2022 Jun 29:e024721. doi: 10.1161/JAHA.121.024721. Epub ahead of print. PMID: 35766251.