Comparison of Surgical Aortopulmonary Shunt with Transcatheter Stenting of Ductus Arteriosus as the Initial Therapy for Pulmonary Atresia with Ventricular Septal Defect

Background: Optimal initial palliation for pulmonary atresia (PAT) with ventricular septal defect is still controversial. This study aims to compare the results of surgical and transcatheter ductus stenting as the initial therapy for PAT and VSD.

Methods: Between 1999 and 2019, we treated 64 patients with the diagnosis of PAT and VSD who had two ventricles. As initial procedure, 34 patients received aortopulmonary shunt and 30 patients transcatheter ductal stenting. In shunt group median age was 34 days and median weight 4.3 kg; in stent group median age was 6.5 days and median weight was 2.95 kg (p = 0.02). In shunt group 5 patients (14.7%) and in stent group 10 patients (33.3%) were under 2.5 kg. Among 64 patients 63 underwent corrective surgery at a median of 343 days.

Results: There was no difference of hospital stay between groups (p = 0.4). No hospital mortality was observed in both groups. In the same hospitalization, 10 patients in the shunt (29.4%) and 7 patients in the stent group (23.3%) needed reinterventions (p = 0.485). Interstage time until corrective surgery was longer in shunt group (p = 0.002). During interstage period no mortality was observed in both groups. Total number of reinterventions was not significant (p = 0.683). All patients in shunt and 29 out of 30 patients in stent group underwent corrective surgery (p = 0.283). Requirement of additional pulmonary artery patchplasty during corrective surgery was higher in the stent group (67% vs. %35.3; p = 0.011). There was no early mortality after corrective surgery in the stent group but one in shunt group (2.9%; p = 0.3). There was no late mortality in both groups. Total need of pulmonary artery interventions at any time after the initial procedure was not significant between groups (p = 0.490). Median follow-up was 8 years in shunt and 7.95 years in stent group.

Conclusion: Both techniques can be used successfully as the initial therapy option. Successful corrective surgery can be achieved after both techniques. Requirement of reinterventions are still an issue for both groups. Novel finding of our study is that the stent group requires patchplasty of pulmonary arteries more often during corrective surgery, whereas total pulmonary artery interventions do not differ between groups. Ductal stent implantation can be considered as a good alternative to surgical shunt, especially in patients with low birth-weight.