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Paliação Transcateter para Tetralogia de Fallot

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Francisco Chamié at Hospital Federal dos Servidores do Estado
Francisco Chamié
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Arq Bras Cardiol. 2021; 117(4):664-665
Short Editorial
Transcatheter Palliation for Tetralogy of Fallot
Francisco Chamié1
Intercat - Cardiologia Intervencionista,1 Botafogo, RJ - Brazil
Short Editorial related to the article: Palliative Endovascular Intervention in Infants with Tetralogy of Fallot: A Case Series
Mailing Address: Francisco Chamié •
R. Ministro Armando de Alencar, 16/201. Postal Code 22.471-080,
Lagoa, RJ – Brazil
E-mail: chamief@gmail.com
Keywords
Tetralogy of Fallot; Cyanosis; Cardiac Catheterization; Stents.
The Tetralogy of Fallot (TOF) is the most common cyanotic
congenital heart defect. The morphologic key feature of TOF is
the malalignment of the infundibular septum. The infundibular
septum malalignment makes the aorta override interventricular
septum (dextroposition) over a large ventricular septal defect
(VSD) and promotes obstruction to the right ventricular
infundibular tract. The pulmonary valve is also stenotic, and the
pulmonary trunk and arteries are, to some degree, hypoplastic.
Severe obstruction to pulmonary blood flow (PBF) leads to more
systemic unsaturation and, thus, prolonged hypoxia.
Open heart surgery is the traditional treatment modality,
augmenting the right ventricular outflow tract (RVOT), closing
the VSD, thus redirecting the aorta to the left ventricle,
correcting the cardiac anatomy, and normalizing systemic
flow saturation.1
Some patients are not candidates for early surgery due to
insufficient body weight, small pulmonary artery size (bad
anatomy), prematurity, neurologic impairment, or associated
defects.2,3 In those cases, palliative procedures are necessary
to increase PBF and systemic oxygen saturation, reducing
levels of hypoxia. Ideal palliation would offer a stable and
symmetric pulmonary blood flow source and adequate growth
of pulmonary arteries, leaving behind no residues that can
impair corrective surgery.
The most traditional form of palliation is the Blalock-Taussig
Shunt (BTS), idealized by Alfred Blalock and Helen Taussig and
first performed in 1944 by Alfred Blalock.4 Classic BTS consists of
right subclavian artery anastomosis to the right pulmonary artery
when the aortic arch is left-sided. When the aorta is right-sided,
the anastomosis is performed in the left subclavian artery.
Modified BTS using interposition of a PTFE tube graft was
later developed in the ‘70s aiming to preserve subclavian flow
to the ipsilateral arm.5 Although effective, BTS has some issues,
including selective PBF, unequal development of pulmonary
arteries, suture-mediated pulmonary branch stenosis, and
shunt occlusion with consequent hypoxemia. In addition, it
should be considered that transporting a severely ill patient
to the operating room is a risk in itself.
Non-surgical palliation alternatives were pursued, and
several strategies were offered, such as pulmonary balloon
valvuloplasty (PBV) and ductal or RVOT stenting.
PBV is effective in cases where the main obstructive
feature is the pulmonary valve, having reduced efficacy
when significant infundibular stenosis is present. In that case,
effective palliation has short-term efficacy.6
Ductal stenting is a safe and effective procedure when
performed in experienced centers. It has comparable results to
BTS in selected patients with ductal-dependent PBF. Glatz et al.
report on 106 patients treated with ductal stenting versus 251
patients treated with BTS. Primary composite outcomes (death
or reintervention) were more common in the BTS group (29.5%
vs 17%, p= 0.014) due mainly to unplanned reinterventions for
cyanosis relief (10.4% x 6.6%, p=0.26). As anticipated, procedural
complications were more commonly found in the BTS group,
although without statistical significance. Pulmonary artery growth
in the ductus stenting group was greater and more symmetric
(p=0.015).7 Possible complications of ductal stenting are in-stent
re-stenosis, intimal proliferation, and stent obstruction.8
RVOT stenting emerged as a compelling technique for TOF
palliation. Relief of infundibular obstruction and pulmonary valve
stenosis by bare-metal stent implantation in the RVOT can lead
to stable PBF and satisfactory growth of pulmonary arteries.9-13
RVOT stenting improves the pulsatile flow of systemic
venous blood to the pulmonary artery, improving oxygen
saturation without a decline in diastolic aortic pressure
and resultant coronary perfusion. A systematic review and
meta-analysis by Ghaderian et al. showed high clinical efficacy
of RVOT stenting in achieving adequate pulmonary arterial
growth during palliation and obtaining proper arterial oxygen
saturation. They also showed low post-procedure morbidity and
mortality following RVOT stenting and no significant difference
in procedural outcomes.14 In small patients and complex
anatomies, RVOT stenting allows for surgical correction in a later
stage. Stent removal during surgery, albeit feasible, lengthens by-
pass time and, in most cases, determines the use of transannular
patches at the time of definitive surgery.15
In the current issue of Arquivos Brasileiros de Cardiologia,
Kupas et al.16 reported on six infants treated by RVOT stenting.
The median age at the moment of the implant was 146.5 days
and 367 days at the moment of stent implant and retrieval,
respectively. Four patients had an infundibular obstruction,
and two patients predominantly had a valvar obstruction.
The immediate post-procedure evaluation showed a reduction
of the peak systolic gradient, increased pulmonary arteries size
and systemic oxygen saturation. Overall mortality was 33%.
Thus, albeit constituting a very small case series, the authors
propose stent implantation in RVOT as an interesting and
appealing option for TOF palliation in very sick neonates.16
Transcatheter palliation may direct high-risk patients to
the path for complete and physiologic resolution of TOF.
New techniques on the horizon make TOF treatment very
likely to be performed less invasively, with catheter-based
and/or hybrid procedures.17
DOI: https://doi.org/10.36660/abc.20210735
664
Arq Bras Cardiol. 2021; 117(4):664-665
Short Editorial
Chamié
Transcatheter Palliation for Tetralogy of Fallot
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Transcatheter Stenting of the Right Ventricular Outflow Tract Augments
Pulmonary Arterial Growth in Symptomatic Infants with Right Ventricular
Outflow Tract Obstruction and Hypercyanotic Spells. Cardiol Young.
2016;26(7):1260-5. doi: 10.1017/S1047951115002231.
10. Quandt D, Ramchandani B, Penford G, Stickley J, Bhole V, Mehta C, et al. Right
Ventricular Outflow Tract Stent Versus BT Shunt Palliation in Tetralogy of Fallot.
Heart. 2017;103(24):1985-91. doi: 10.1136/heartjnl-2016-310620.
11. Sandoval JP, Chaturvedi RR, Benson L, Morgan G, Van Arsdell G, Honjo
O, et al. Right Ventricular Outflow Tract Stenting in Tetralogy of Fallot
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13. TanıdırİC,BulutMO,KamalıH,ÖztürkE,YücelİK,GüzeltaşA,etal.Right
Ventricular Outflow Tract Stenting During Neonatal and Infancy Periods: A
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with Tetralogy of Fallot: A Case Series. Arq Bras Cardiol. 2021; 117(4):657-663.
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References
This is an open-access article distributed under the terms of the Creative Commons Attribution License
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... However, although it is the only effective treatment option, it has some contraindications, such as insufficient weight of the newborn, prematurity, small size of the pulmonary artery, neurological impairment or associated defects. 5 Although medical science has evolved significantly in recent years, the ideal age for surgical repair is still controversial. In this sense, Oliveira 2 , states that surgical intervention up to 12 months of age is known to be more effective than late intervention, being responsible for the reduction in mortality, but although it is associated with improvements, early treatment, in addition to the contraindications described above, can only be performed in asymptomatic patients, which limits the use of this therapy. ...
... 15,16 Total correction is usually performed before the age of 12 months and has a low mortality rate, but is associated with late right ventricular dilatation and prolonged mechanical ventilation. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Still, it is believed that the advantages of total surgery outweigh the disadvantages, since such an approach allows the correction of the problem in a single surgical time, shortens the right-left shunt time, reduces the length of stay of cyanosis and polycythemia, and the left ventricular volume 18 . It is considered a promising treatment as the perioperative mortality rate in uncomplicated ET is less than 5%. ...
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... Para pacientes sintomáticos que não são eletivos cirurgicamente por terem má anatomia e baixo peso ao nascimento, o uso do implante de stent na via de saída do ventrículo direito -VSVD para sua desobstrução tem se mostrado um procedimento promissor para o tratamento da sintomatologia da tetralogia de Fallot, tendo uma taxa de óbito de 33%, podendo ser um caminho promissor para tratamento (KUPAS, 2021;CHAMIÉ, 2021). ...
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Este livro traz trabalhos sobre um dos sistemas vitais para nossa vida, responsável pelas principais incidências de mortalidade e morbidades, o sistema cardiovascular. Ele possui o coração como ator principal, caracterizado por batidas e frequências graciosamente rítmicas para distribuir sangue e oxigênio a todos os outros órgãos e manter a pressão arterial, filtração glomerular e tantas outras tarefas vitais. Até o final de 1800 a cirurgia cardíaca era algo impensado, entretanto, os avanços da ciência médica permitiram o advento de tratamentos eficientes, cirurgias minuciosamente realizadas de forma presencial e até remota, políticas públicas eficazes para prevenção, controle e tratamento das doenças cardiovasculares. Muitos estudantes, profissionais da área e pesquisadores tornaram este livro possível. Portanto, a Editora Pasteur deixa aqui o seu muito obrigado a todos e deseja uma ótima leitura nesta coletânea de estudos sobre o campo da Cardiologia.
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... Além disso, diretrizes brasileiras sobre o tema também foram usadas para a produção desta revisão literária. Sendo assim, todos os artigos que não se enquadraram nesses critérios foram desconsiderados, e a partir disso, foram selecionados 12 artigos que respeitaram os critérios de inclusão 2,3,4,5,6,7,8,9,10,11,12 . congênitas, e em alguns casos, o exame de ecocardiografia fetal, para permitir o diagnóstico confirmatório da cardiopatia congênita 2 . ...
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RESUMO –A tetralogia de Fallot é a cardiopatia congênita cianótica mais comum. Caracteriza-se por tétrade de malformações anatômicas que incluem estenose pulmonar, defeito do septo ventricular, hipertrofia do ventrículo direito e dextroposição da aorta (cavalgamento da aorta). O objetivo deste estudo foi analisar e descrever as alterações anatômicas cardíacas, tratamento e prognóstico de pacientes com a doença. É revisão narrativa de artigos indexados na base de dados PubMed, Google Acadêmico e LILACS utilizando os descritores “tetralogy of Fallot”, “congenital heart disease”, “cyanotic disease”. Em conclusão, a tetralogia de Fallot é cardiopatia congênita comum e com prognóstico ruim caso não seja realizado diagnóstico e tratamento precoces. O seguimento médico contínuo e próximo ao paciente é importante para acompanhar a evolução e programar novas intervenções caso necessárias.
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Cardiopatia congênita na infância: tetralogia de Fallot: revisão de literatura
Article
  • Jan 2022
Introdução: As cardiopatias congênitas podem ser classificadas em cianóticas e acianóticas. Entre as cianóticas, destaca-se a tetralogia de Fallot, caracterizada por quatro alterações cardíacas: comunicação interventricular, cavalgamento da aorta, bloqueio de saída do ventrículo direito com consequente hipertrofia ventricular direita. Essa patologia acarreta alterações no fluxo sanguíneo, sendo manifestado por cianose de vários graus, dependente da obstrução na saída do ventrículo direito. Objetivo: coletar as informações existentes sobre tetralogia de Fallot através de uma revisão de literatura nos últimos cinco anos. Metodologia: foi realizada uma revisão de literatura que consistiu na busca relacionada ao tema da pesquisa na base de informações médicas (UpToDate) e na biblioteca eletrônica científica online (SciELO). Foram escolhidos trabalhos publicados nos últimos cinco anos nas línguas inglesa e portuguesa. A partir das buscas, foram encontrados quinze artigos que abordavam o tema proposto. Conclusão: O manejo da Tetralogia de Fallot depende de uma intervenção cirúrgica, paliativa ou definitiva, antes do primeiro ano de vida para obter um bom prognóstico.
View
Intervenção Paliativa Endovascular no Lactente com Tetralogia de Fallot: Uma Série de Casos
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Full-text available
  • Jul 2021
Background: Endovascular stent placement in the right ventricular outflow tract (RVOT) has been an alternative to Blalock-Taussig (BT) surgery in the treatment of Tetralogy of Fallot (TOF) in symptomatic infants with low birth weight and complex anatomy. Objective: To evaluate endovascular stent placement in the RVOT as a primary treatment for infants with TOF who are not candidates for BT surgery, and evaluate medium-term outcomes until the stent is removed during corrective surgery. Methods: Six infants with TOF were treated with RVOT stenting from October 2015 to April 2018. Hemodynamic parameters were compared between the pre- and post-stenting periods. Results: At the time of stenting, participants had a median age and weight of 146.5 days and 4.9 kg, respectively. Peak systolic gradient decreased from 63.5 mm Hg to 50.5 mm Hg, while the diameter of the left and right pulmonary arteries increased from 3.5 mm to 4.9 mm and 4.3 mm, respectively. The Nakata index increased from 96.5 mm to 108.3 mm; weight increased from 4.9 kg to 5.5 kg; and oxygen saturation, from 83.5% to 93%. There was one case of stent migration and two deaths, one caused by stent embolization and the other unrelated to study procedures. Conclusions: RVOT stenting is a promising alternative for the palliative treatment of TOF in infants with low birth weight and complex anatomy.
View
Right ventricular outflow tract stenting during neonatal and infancy periods: A multi-center, retrospective study
Article
Full-text available
  • Jul 2020
Background: The aim of this study was to evaluate the outcomes of right ventricular outflow tract stenting for palliation during the newborn and infancy periods. Methods: Between January 2013 and January 2018, a total of 38 patients (20 males, 18 females; median age 51 days; range, 3 days to 9 months) who underwent transcatheter right ventricular outflow tract stenting in three centers were retrospectively analyzed. Demographic characteristics, cardiac pathologies, angiographic procedural, and clinical follow-up data of the patients were recorded. Results: The diagnoses of the cases were tetralogy of Fallot (n=27), double outlet right ventricle (n=8), complex congenital heart disease (n=2), and Ebstein"s anomaly (n=1). The median weight at the time of stent implantation was 3.5 (range, 2 to 10) kg. Five cases had genetic abnormalities. The median pre-procedural oxygen saturation was 63% (range, 44 to 80%), and the median procedural time was 60 (range, 25 to 120) min. Acute procedural success ratio was 87%. Reintervention was needed in seven of patients due to stent narrowing during follow-up. During follow-up period, seven cases died. Total correction surgery was performed in 26 patients without any mortality. While a transannular patch was used in 22 patients, valve protective surgery was implemented in two patients, and the bidirectional Glenn procedure was performed in two patients. Conclusion: Based on our study results, right ventricular outflow tract stenting is a form of palliation which should be considered particularly in cases in whom total correction surgery is unable to be performed due to morbidity.
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Predicting the Future: Tetralogy of Fallot Will Be Primarily Treated with Catheter Based Intervention Within Two Decades. Surgeon’s Perspective
Article
Full-text available
  • Mar 2020
  • PEDIATR CARDIOL
Interventional cardiology has made extraordinary advances over recent years, but most are still limited to addressing single intracardiac or valvular lesions. This debate considers whether complete interventional repair of more complex congenital defects might become achievable. Tetralogy of Fallot (ToF) is probably the first candidate where complete interventional repair might be achieved—given that various components of the defect have already been successfully addressed—albeit as either a palliative intervention (RVOT stenting) or to address the sequelae of standard surgery (percutaneous PVR). This article considers the challenges that would need to be overcome in terms of the morphology of the condition, the age limitations, and the necessary technological advancements that would be required—while setting these against the benchmark of current surgical outcomes and the parallel progress that is being developed in surgical correction. While complete interventional repair of ToF may still be beyond current techniques, a hybrid approach between surgeons and intentional cardiologists can strive to create a life-long paradigm of care that minimizes the need for surgery and focuses on the maintenance of a healthy right ventricle, such that patients born with ToF can achieve normal life expectancy.
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Short And Midterm Outcome Of Fallot's Tetralogy Repair In Infancy: A Single Center Experience In A Developing Country
Article
Full-text available
  • Jul 2019
Background: Primary repair of ToF between 3-12 months is the preferred mode of treatment worldwide, with low surgical mortality. This study reviews our experience of ToF repair in infancy and its short and midterm outcomes in a single centre from a developing country. Methods: Data of all patients with Tetralogy of Fallot repair during infancy from January 2007 to Feb 2018 was reviewed. Preoperative, operative, and postoperative data was analysed. Outcome of the infants was assessed through discharge/death, low cardiac output syndrome (LCOS), prolonged intubation, duration of cardiac intensive care unit (CICU) and hospital stay. Results: Forty-four patients who underwent TOF repair in infancy during this period were included. The mean age and weight were 9.39±2.32 and 7.20±1.30 respectively, 77.3% (34 patients) were male, 68.18% (30 patients) had saturation >75%. Mean intubation period was 4.05±6.58 days, 12 (27.3%) patients developed LCOS, mean cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and ionotropic score were 133.52±62.4, 98.66±58.62 and 33.27±71.13 respectively. Mean CICU and hospital stay was 6.60±7.18 and 12.05±7.74 respectively. Five (11.3%) patients expired in postoperative period. Baseline saturation ≤75% is independent risk factor for LCOS and prolong intubation period. In the last six years our mortality decreased to 8% from 15.7% during the previous six years, while our mean intubation duration, CPB time, ACC, hospital stay and CICU stay have all shown improvement. Conclusions: TOF repair during infancy is safe procedure in expert hands with acceptable morbidity and mortality. Baseline saturation ≤75% is independent risk factor for LCOS and prolonged intubation period. Last six years have shown considerable improvement in our surgical morbidity and mortality due to improvement in surgical expertise.
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Comparison Between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants With Ductal-Dependent Pulmonary Blood Flow: Insights From the Congenital Catheterization Research Collaborative
Article
Full-text available
  • Oct 2017
Background: Infants with ductal-dependent pulmonary blood flow may undergo palliation with either a patent ductus arteriosus (PDA) stent or a modified Blalock-Taussig (BT) shunt. A balanced multicenter comparison of these 2 approaches is lacking. Methods: Infants with ductal-dependent pulmonary blood flow palliated with either a PDA stent or a BT shunt from January 2008 to November 2015 were reviewed from the 4 member centers of the Congenital Catheterization Research Collaborative. Outcomes were compared by use of propensity score adjustment to account for baseline differences between groups. Results: One hundred six patients with a PDA stent and 251 patients with a BT shunt were included. The groups differed in underlying anatomy (expected 2-ventricle circulation in 60% of PDA stents versus 45% of BT shunts; P=0.001) and presence of antegrade pulmonary blood flow (61% of PDA stents versus 38% of BT shunts; P<0.001). After propensity score adjustment, there was no difference in the hazard of the primary composite outcome of death or unplanned reintervention to treat cyanosis (hazard ratio, 0.8; 95% confidence interval [CI], 0.52-1.23; P=0.31). Other reinterventions were more common in the PDA stent group (hazard ratio, 29.8; 95% CI, 9.8-91.1; P<0.001). However, the PDA stent group had a lower adjusted intensive care unit length of stay (5.3 days [95% CI, 4.2-6.7] versus 9.19 days [95% CI, 7.9-10.6]; P<0.001), a lower risk of diuretic use at discharge (odds ratio, 0.4; 95% CI, 0.25-0.64; P<0.001) and procedural complications (odds ratio, 0.4; 95% CI, 0.2-0.77; P=0.006), and larger (152 mm2/m2 [95% CI, 132-176] versus 125 mm2/m2 [95% CI, 113-138]; P=0.029) and more symmetrical (symmetry index, 0.84 [95% CI, 0.8-0.89] versus 0.77 [95% CI, 0.75-0.8]; P=0.008] pulmonary arteries at the time of subsequent surgical repair or last follow-up. Conclusions: In this multicenter comparison of palliative PDA stent and BT shunt for infants with ductal-dependent pulmonary blood flow adjusted for differences in patient factors, there was no difference in the primary end point, death or unplanned reintervention to treat cyanosis. However, other markers of morbidity and pulmonary artery size favored the PDA stent group, supporting PDA stent as a reasonable alternative to BT shunt in select patients.
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Initial Palliation of Tetralogy of Fallot: A Comparison Between BT shunt and Right Ventricular Outflow Tract Stenting
Poster
Full-text available
  • Nov 2016
Background: Neonatal repair of symptomatic infants with Fallot-type(ToF) lesions remains the exception in the UK. Initial palliation can be achieved by creation of a BT shunt, or RVOT stenting. Aims: To compare the outcome of BTS and RVOT stent in the palliation of TOF. Methods: 10 year retrospective review of the outcome of 101 ToF patients who required initial palliation (RVOT stent n=60 ; BTS n=41) prior to complete repair. Detailed assessment of PA growth in patients with comparable underlying anatomy. Results: In the RVOT stent group vs the BT shunt group, there was a lower PICU admission rate (22% vs 100%) [p<0.001], a lower early mortality (1.7% vs 4.9%] [ns], a shorter initial hospital stay (7 vs 14 days) [p<0.004], and a shorter time to surgical repair (232 vs 428 days) [p<0.001]. In terms of PA growth after palliation, the benefit of RVOT stenting versus mBTS was 0.599 z-score for the LPA and 0.749 z-score for the RPA. Rise in oxygen saturations was greater with RVOT stenting (p=0.012). There were 3 non-cardiac deaths in the RVOT stent group and none in the BTS group. There were no deaths after correction, and comparable bypass times and rate of transannular patching / conduit use. Overall mortality was comparable (8.4% vs 4.9%) [p = 0.69]. Conclusions: RVOT stenting is a safe and effective palliation in the initial treatment of infants with symptomatic Fallot-type lesions and promotes pulmonary artery growth.
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Right Ventricular Outflow Tract Stenting in Tetralogy of Fallot Infants With Risk Factors for Early Primary Repair
Article
Full-text available
  • Dec 2016
Background— Tetralogy of Fallot with cyanosis requiring surgical repair in early infancy reflects poor anatomy and is associated with more clinical instability and longer hospitalization than those who can be electively repaired later. We bridged symptomatic infants with risk factors for early primary repair by right ventricular outflow tract stenting (stent). Methods and Results— Four groups of tetralogy of Fallot with confluent central pulmonary arteries were studied: stent group (n=42), primary repair (aged <3 months) with pulmonary stenosis (early-PS group; n=44), primary repair (aged <3 months) with pulmonary atresia (early-PA group; n=49), and primary repair between 3 and 11 months of age (surg>3mo group; n=45). Stent patients had the smallest pulmonary arteries with a median (95% credible intervals) Nakata index (mm ² /m ² ) of 79 (66–85) compared with the early-PA 139 (129–154), early-PS 136 (121–153), and surg>3mo 167 (153–200) groups. Only stent infants required unifocalization of aortopulmonary collaterals (17%). Stent and early-PA infants had younger age and lower weight than early-PS infants. Stent infants had the most multiple comorbidities. Stenting allowed deferral of complete surgical repair to an age (6 months), weight (6.3 [5.8–7.0] kg), and Nakata index (147 [132–165]) similar to the low-risk surg>3mo group. The 3 early treatment groups had similar intensive care unit/hospital stays and high reintervention rates in the first 12 months after repair, compared with the surg>3mo group. Conclusions— Right ventricular outflow tract stenting of symptomatic tetralogy of Fallot with poor anatomy (small pulmonary arteries) and adverse factors (multiple comorbidities, low weight) relieves cyanosis and defers surgical repair. This allowed pulmonary arterial and somatic growth with clinical results comparable to early surgical repair in more favorable patients.
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Clinical Outcome of Right Ventricular Outflow Tract Stenting Versus Blalock-Taussig Shunt in Tetralogy of Fallot: A systematic Review and Meta-Analysis
Article
  • Jun 2020
  • CURR PROB CARDIOLOGY
Aim: Several studies assessed the effectiveness of different therapeutic procedures for repairing right ventricular outflow tract (RVOT) in tetralogy of Fallot (TOF) patients reporting contradictory results. What has been systematically summarized in the present study was to assess the outcome of RVOT stenting in TOF patients and also to compare its outcome with Blalock-Taussig (BT) shunt procedure. Methods and Results: This study was performed according to established methods and in compliance with PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis) Protocols. Two investigators searched the manuscript databases including Medline, Web of knowledge, Google scholar, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library for all eligible studies in accordance with the considered keywords. In final, 10 articles were eligible for the final analysis. The pooled success rate of RVOT stenting was found to be 93.6% (95%CI: 89.6% to96.2%). The overall improvement in arterial oxygen saturation following RVOT stenting was also shown to be 20.1%% (95%CI: 15.8% to 25.3%). The procedural-related death was also 3.7% (95%CI: 1.9% to7.3%). The assessment of the outcome of RVOT stenting and BT shunt showed no significant difference in improvement rate of arterial O2 saturation (OR = 1.419, 95%CI: 0.645 to 3.123, p = 0.384) and death rate (RR = 0.341, 95%CI: 0.057 to 2.024, p = 0.236). Conclusion: RVOT stenting leads to appropriate clinical outcome in children suffering TOF Comparing RVOT stenting and BT shunt shows comparable results with respect to clinical sequels. Classifications: Right Ventricular Outflow Tract (RVOT), Tetralogy of Fallot(TOF), Blalock-Taussig (BT) shunt Condensed Abstract: Aim: present study was to assess the outcome of RVOT stenting in TOF patients and also to compare its outcome with Blalock-Taussig (BT) shunt procedure. Methods and Results: This study was performed according to established methods and in compliance with PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis) Protocols. In final, 10 articles were eligible for the final analysis. The assessment of the outcome of RVOT stenting and BT shunt showed no significant difference in improvement rate of arterial O2 saturation and death rate. Conclusion: RVOT stenting leads to appropriate clinical outcome in children suffering TOF Comparing RVOT stenting and BT shunt shows comparable results with respect to clinical sequels.
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Right ventricular outflow tract stent versus BT shunt palliation in Tetralogy of Fallot
Article
  • Aug 2017
Objective: This study sets out to compare morbidity, mortality and reintervention rates after stenting of the right ventricular outflow tract (RVOT) versus modified Blalock-Taussig shunt (mBTS) for palliation in patients with tetralogy of Fallot (ToF)-type lesions. Methods: Retrospective case review study evaluating 101 patients (64 males) with ToF lesions who underwent palliation with either mBTS (n=41) or RVOT stent (n=60) to augment pulmonary blood flow over a 10-year period. Procedure-related morbidity, mortality and reintervention rates were assessed and compared. Results: Admission rate to paediatric intensive care unit (PICU) was lower in the RVOT stent group (22%vs100%; p<0.001). Thirty-day mortality in the RVOT stent group was (1/60 (1.7%)) compared with (2/41 (4.9%)) in the mBTS group (p=0.565). Mortality until surgical repair was comparable in both groups (5/60, 8.4%, including three non-cardiac death in the RVOT stent group vs 2/41, 4.9% (p=0.698)). Total hospital length of stay was shorter for the RVOT stent group (median 7 days vs 14 days; p<0.003). Time to surgical repair was shorter in the RVOT stent group (median 232 days, IQR 113-360) compared with the mBTS group (median 428 days, IQR 370-529; p<0.001) due to improved pulmonary arterial growth. Conclusion: RVOT stenting in Fallot-type lesions can be accomplished safely, with lower PICU admission rate, a shorter hospital length of stay and shorter duration of palliation until complete repair compared with mBTS palliation.
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Transcatheter stenting of the right ventricular outflow tract augments pulmonary arterial growth in symptomatic infants with right ventricular outflow tract obstruction and hypercyanotic spells
Article
  • Mar 2016
  • CARDIOL YOUNG
We retrospectively reviewed all the children with right ventricular outflow tract obstruction, hypoplastic pulmonary annulus, and pulmonary arteries who underwent stenting of the right ventricular outflow tract for hypercyanotic spells at our institution between January, 2008 and December, 2013; nine patients who underwent cardiac catheterisation at a median age of 39 days (range 12-60 days) and weight of 3.6 kg (range 2.6-4.3 kg) were identified. The median number of stents placed was one stent (range 1-4). The median oxygen saturation increased from 60% to 96%. The median right pulmonary artery size increased from 3.3 to 5.5 mm (-2.68 to -0.92 Z-score), and the median left pulmonary artery size increased from 3.4 to 5.5 mm (-1.93 to 0 Z-scores). Among all, one patient developed transient pulmonary haemorrhage, and one patient had pericardial tamponade requiring drainage. Complete repair of tetralogy of Fallot +/- atrioventricular septal defect or double-outlet right ventricle was achieved in all nine patients. Transcatheter stent alleviation of the right ventricular outflow tract obstruction resolves hypercyanotic spells and allows reasonable growth of the pulmonary arteries to facilitate successful surgical repair. This represents a viable alternative to placement of a systemic-to-pulmonary artery shunt, particularly in small neonates.
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