Duct stenting versus modified Blalock-Taussig shunt in neonates and infants with duct-dependent pulmonary blood flow: a systematic review and meta-analysis

Abstract Objective The aim of this systematic review and meta-analysis is to evaluate whether duct stenting (DS) is associated with better survival and other clinical outcomes compared to modified Blalock-Taussig shunt (BTS) in infants with a duct-dependent pulmonary flow. Methods A systematic search of Medline, Embase, and Cochrane databases was performed by four independent reviewers from inception to March 2019. Meta-analysis was performed using DerSimonian and Laird method with inverse-variance weighting. The quality of evidence was summarized using the GRADE framework. Results Six comparative observational studies were included, of which three were rated low risk of bias. There was no difference in 30-day mortality between BTS and DS (risk ratio [RR]: 1.02, 95% CI: 0.46 to 2.27, P=.96, I2=0%). However, there was benefit in favour for DS for medium-term mortality (RR: 0.63, 95% CI: 0.40 to 0.99, P=.05, I2=0%). DS demonstrated a reduced risk for procedural complications compared to BTS (RR: 0.50, 95% CI: 0.31 to 0.81, P=.005, I2=0%). However, there was an increased risk for unplanned re-intervention for DS (RR: 1.77, 95% CI: 1.39 to 2.26, P Conclusions DS demonstrated comparable early mortality, lower medium-term mortality, lower risk of procedural complications, and higher risk of re-intervention compared to BTS.