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Review
. 2022 Jul 7;1(6):100392.
doi: 10.1016/j.jscai.2022.100392. eCollection 2022 Nov-Dec.

Stenting of the Patent Ductus Arteriosus: A Meta-analysis and Literature Review

Holly Bauser-Heaton  1 , Katherine Price  2 , Rachel Weber  3 , Howaida El-Said  3
Affiliations
Review

Stenting of the Patent Ductus Arteriosus: A Meta-analysis and Literature Review

Holly Bauser-Heaton et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Background: Patent ductus arteriosus (PDA) stent placement and systemic-pulmonary surgical shunt procedure can both be performed as palliation for infants with duct-dependent pulmonary circulation. The aim of this meta-analysis and literature review was to compare outcomes and study populations between the 2 methods as well as review the technical considerations and complications of PDA stenting.

Methods: A systematic search was conducted using the PubMed database and meta-analysis was performed. Risk ratio and mean difference were used to compare the reported outcomes of studies across patients receiving PDA stent and surgical shunt.

Results: In total, 1094 patients from 8 comparative observational studies were included. The PDA stent group had a lower mortality rate and a shorter hospital length of stay than the systemic-pulmonary surgical shunt group, although at the expense of increased reintervention rates. There were higher proportions of patients with single-ventricle physiology and single-source pulmonary blood flow in the surgical shunt group.

Conclusions: PDA stenting appears to be a noninferior or possibly superior method of palliation for duct-dependent pulmonary circulation compared with systemic-pulmonary surgical shunt, recognizing, however, that patients receiving surgical shunt more often had single-ventricle physiology or single-source pulmonary blood flow in this meta-analysis.

Keywords: congenital heart disease; duct-dependent pulmonary circulation; palliation; patent ductus arteriosus; shunt; stent.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Flow diagram of study selection. Of 181 screened articles, 8 articles were ultimately included in the meta-analysis.
Central Illustration
Central Illustration
Forestplot of total mortality. Pooled estimates favor the patent ductus arteriosus stent group.
Figure 2
Figure 2
Forest plot of total reintervention. Each “event” represents a reintervention. Pooled estimates favor the shunt group (more freedom from reintervention in the shunt group).
Figure 3
Figure 3
Forest plot of reintervention directly related to the stent or shunt. Each “event” represents a reintervention. Pooled estimates favor the shunt group (more freedom from reintervention in the shunt group).
Figure 4
Figure 4
Forest plot of hospital length of stay. Pooled estimates favored the patent ductus arteriosus stent group.
Figure 5
Figure 5
Hospital length of stay showing trend toward shorter length of stay for the patent ductus arteriosus stent group (weighted average of all studies).
Figure 6
Figure 6
Proportions of patients with single-ventricle physiology and single-source pulmonary blood flow in the patent ductus arteriosus stent and surgical shunt groups, showing higher proportions in the shunt group. PBF, pulmonary blood flow.
Figure 7
Figure 7
Weighted average change in the Nakata index in patients with stent versus shunt in available studies. PA, pulmonary artery.
Figure 8
Figure 8
Analysis of complication data favoring stent in total comparison.
See this image and copyright information in PMC

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