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Original research article
Right ventricular outflow tract stent versus BT shunt palliation in Tetralogy of Fallot
  1. Daniel Quandt1,2,
  2. Bharat Ramchandani1,
  3. Gemma Penford1,
  4. John Stickley1,
  5. Vinay Bhole1,
  6. Chetan Mehta1,
  7. Timothy Jones1,
  8. David James Barron1,
  9. Oliver Stumper1
  1. 1 The Heart Unit, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
  2. 2 Pediatric Heart Center, University Children’s Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Dr Oliver Stumper, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK; oliver.stumper{at}bch.nhs.uk

Abstract

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% vs 100%; 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.

  • interventional cardiology and endovascular procedures
  • congenital heart disease surgery
  • tetralogy of fallot

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Footnotes

  • Contributors DQ and OS planned this study, performed data acquisition and data analysis and wrote this manuscript. BR and GP assisted in data acquisition and data analysis. JS supported and assisted in the statistical analysis of the data. VB and CM edited the manuscript. TJJ and DJB assisted in the analysis of the surgical data and edited this manuscript.

  • Funding DQ was supported by a research grant by Eleonore Foundation of the University Children’s Hospital Zurich, Medtronic Switzerland and EMDO Stiftung, Switzerland sponsoring a Senior Interventional Fellowship at Birmingham Children’s Hospital.

  • Competing interests None declared.

  • Ethics approval RVOT stenting as an alternative to mBTS surgery was approved by the local hospital ethics review board (Birmingham Children’s hospital NHS Foundation Trust).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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