First palliation for the fragile: Short-term outcomes of ductal stenting versus surgical shunt in small infants with restricted pulmonary blood flow.

Abstract

Background: In congenital heart disease (CHD) with restricted pulmonary blood flow, infants require urgent palliation, either with a modified Blalock-Taussig-Thomas (m-BTT) shunt or ductal stenting. However, evidence in infants weighing under 5 kg remains limited. This study aims to compare short-term outcomes after the two approaches in infants weighing <5 kg.

Methods: This retrospective cohort study included infants weighing under 5 kg diagnosed with CHD and restricted pulmonary blood flow who underwent either ductal stenting or m-BTT shunt between 2018 and 2023 at the National Cardiovascular Centre Harapan Kita. Outcome assessment included mortality, reintervention, rehospitalization, complications, intensive care unit (ICU) stay, and total hospital duration within 30 days.

Results: After the 1:1 propensity score matching, we analyzed 106 infants, comprising 53 infants (mean weight: 3525.7 ± 682.0 g) who underwent ductal stenting and 53 infants (mean: weight 3700.9 ± 649.0 g) who received m-BTT shunt surgery. Mortality (18.9% vs. 22.6%; P = 0.63), reintervention (1.9% vs. 7.5%; P = 0.36), and complication (54.7% vs. 71.7%; P = 0.07) rates were not significantly different between the two groups within 30 days. However, rehospitalization rates (3.8% vs. 15.1%; P = 0.046) were significantly smaller in the ductal stenting group. Furthermore, ductal stenting was associated with significantly shorter durations of both in total hospitalization (8 [1-42] vs. 12 [0-75] days; P < 0.001) and in intensive care stay (2 [0-19] vs. 6 [1-37] days; P < 0.001).

Conclusions: Both ductal stenting and m-BTT shunt demonstrated comparable short-term efficacy in palliating cyanosis among infants weighing <5 kg, with reasonable periprocedural safety in both the groups. Ductal stenting was associated with shorter total and ICU length of stay as well as lower rehospitalization rates, suggesting potential recovery advantages, though prospective studies are needed to guide individualized decision-making.