Critical form of tetralogy of Fallot: right ventricular outflow tract stenting or modified Blalock-Taussig shunt?

Morsina MG, Pursanov MG, Soynov IA, Voitov AV, Kulyabin YuYu, Gorbatykh YuN, Bogachev-Prokofiev AV. Critical form of tetralogy of Fallot: right ventricular outflow tract stenting or modified Blalock-Taussig shunt? Russian Journal of Cardiology and Cardiovascular Surgery. 2023;16(6):575‑581. (In Russ., In Engl.)
https://doi.org/10.17116/kardio202316061575

Подписка 2026 Кардиология и сердечно-сосудистая хирургия (Russian Journal of Cardiology and Cardiovascular Surgery)

Использование инфографики авторами научных работ

Close metadata

OBJECTIVE

To compare the results of right ventricular outflow tract stenting and modified Blalock-Taussig shunt in infants with tetralogy of Fallot and severe pulmonary hypoplasia.

MATERIAL AND METHODS

A prospective randomized two-center study enrolled 42 patients with tetralogy of Fallot who underwent modified Blalock-Taussig shunt (n=21) or right ventricular outflow tract stenting (n=21) as a bridge to complete repair. We assessed baseline characteristics of patients before palliative care and compared the results of both procedures.

RESULTS

Mean duration of surgery (p<0.0001), vasopressor and inotropic support (p<0.0001), mechanical ventilation (p<0.0001) and hospital-stay (p<0.0001) was significantly lower after right ventricular outflow stenting. Oxygen saturation increase averaged 30% in the same patients (from 63 to 94%) compared to 17% after modified Blalock-Taussig shunt (from 69 to 87%) (p<0.00001).

CONCLUSION

Right ventricular outflow tract stenting in infants with tetralogy of Fallot is a safe procedure providing stabilization of hemodynamics, fact and significant increase in oxygen saturation with shorter period of rehabilitation.

Keywords:

staged treatment of tetralogy of Fallot

right ventricular outflow tract stenting

modified Blalock-Taussig shunt

Authors:

Morsina M.G.

Meshalkin National Medical Research Center

ORCID: 0000-0003-3870-169X

Pursanov M.G.

Meshalkin National Medical Research Center

ORCID: 0000-0002-1421-1795

Soynov I.A.

Meshalkin National Medical Research Center

ORCID: 0000-0003-3691-2848

Voitov A.V.

Meshalkin National Medical Research Center

ORCID: 0000-0003-3797-4899

Kulyabin Yu.Yu.

National Medical Research Center

ORCID: 0000-0002-2361-5847

Gorbatykh Yu.N.

Meshalkin National Medical Research Center

ORCID: 0000-0002-6204-5381

Bogachev-Prokofiev A.V.

Meshalkin National Medical Research Center

SPIN RSCI: 4448-6999
Scopus AuthorID: 55846629000
ResearcherID: L-7881-2014
ORCID: 0000-0003-4625-4631

Received:

25.07.2023

Accepted:

10.08.2023

Close metadata

References:

Al Habib HF, Jacobs JP, Mavroudis C, Tchervenkov CI, O’Brien SM, Mohammadi S, Jacobs ML. Contemporary patterns of management of tetralogy of Fallot: data from the Society of Thoracic Surgeons database. Ann Thorac Surg. 2010;90:813-820.
Barron DJ. Tetralogy of Fallot: controversies in early management. 8. World J Pediatr Congenit Heart Surg. 2013;4:186-191.
Petrucci O, O’Brien SM, Jacobs ML, et al. Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure. Ann Thorac Surg. 2011;92:642-652.
Quandt D, et al. Right ventricular outflow tract stent versus BT shunt palliation in Tetralogy of Fallot. Heart. 2017;103:1985-1991.
Quandt, et al. RVOT Stenting Promotes Better PA Growth Than mBTS. JACC: Cardiovascular interventions. 2017;10:1774-1784.
Dohlen G, Chaturvedi RR, Benson LN, et al. Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot. Heart. 2009;95:142-147.
Stumper O, Ramchandani B, Noonan P, et al. Stenting of the right ventricular outflow tract. Heart. 2013;99:1603-1608.
Bertram H, Emmel M, Ewert P, et al. Stenting of Native Right Ventricular Outflow Tract Obstructions in Symptomatic Infants. J Interv Cardiol. 2015;28:279-287
Barron DJ, Ramchandani B, Murala J, et al. Surgery following primary right ventricular outflow tract stenting for Fallot’s tetralogy and variants: rehabilitation of small pulmonary arteries. Eur J Cardiothorac Surg. 2013;44:656-662.
Barron DJ, Jegatheeswaran A. How and when should tetralogy of Fallot be palliated prior to complete repair? Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual. WB Saunders. 2021;24:77-84.
Qureshi AM, Caldarone CA, Wilder TJ. Transcatheter Approaches to Palliation for Tetralogy of Fallot. Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual. WB Saunders. 2022;25:48-57.
Chubb H, Simpson JM. The use of Z-scores in paediatric cardiology. Ann Pediatr Cardiol. 2012;5:179-184.
Kanter KR, Kogon BE, Kirshbom PM, et al: Symptomatic neonatal tetralogy of Fallot: repair or shunt? Ann Thorac Surg. 2010;89:858-863.
Williams JA, Bansal AK, Kim BJ, et al. Two thousand Blalock-Taussig shunts: a sixdecade experience. Ann Thorac Surg. 2007;84:2070-2075.
Gladman G, McCrindle BW, Williams WG, et al. The modified Blalock-Taussig shunt: clinical impact and morbidity in Fallot’s tetralogy in the current era. J Thorac Cardiovasc Surg. 1997;114:25-30.
Ahmad U, Fatimi SH, Naqvi I, et al. Modified Blalock-Taussig shunt: immediate and short-term follow-up results in neonates. Heart Lung Circ. 2008;17:54-58.
Dirks V, Prêtre R, Knirsch W, et al. Modified Blalock Taussig shunt: a not-so-simple palliative procedure. Eur J Cardiothorac Surg. 2013;44:1096-1102.
Dave HH. Modified Blalock-Taussig shunt: simple but unpredictable. Eur J Cardiothorac Surg. 2016;50:178-179.
DiDonato RM, Jonas RA, Lang P, et al: Neonatal repair of tetralogy of Fallot with and without pulmonary atresia. J Thorac Cardiovasc Surg. 1991;101:126-137.
Marshall AC, Love BA, Lang P, et al. Staged repair of tetralogy of Fallot and diminutive pulmonary arteries with a fenestrated ventricular septal defect patch. J Thorac Cardiovasc Surg. 2003;126:1427-1433.
Bentham JR, Zava NK, Harrison WJ, et al: Duct stenting versus modified Blalock-Taussig shunt in neonates with duct-dependent pulmonary blood flow: associations with clinical outcomes in a multicenter national study. Circulation. 2018;137:581-588.
Sandoval JP, Chaturvedi RR, Benson L, et al: Right ventricular outflow tract stenting in tetralogy of Fallot infants with risk factors for early primary repair. Circ Cardiovasc Interv. 2016;9:e003979.