The efficacy and safety of patent ductus arteriosus stent versus surgical aortopulmonary shunt in the management of babies with duct dependent circulation: a meta-analysis and review of literature


  • Aditi Das Department of Allied Health Sciences, Srinivas University, Mangalore, Karnataka, India
  • Satish Koirala Department of Paediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India
  • Neeraj Awasthy Department of Paediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India



Patent ductus arteriosus, Aortopulmonary shunt, Duct-dependent circulation


This meta-analysis aims to comprehensively assess the efficacy and safety of both patent ductus arteriosus (PDA) stents and surgical aortopulmonary shunt (APS) as the initial palliative measures in babies relying on ductal-dependent circulation. This review is essential to compare the outcome of relatively newer catheter-based PDA stent procedure with a surgical APS. By synthesizing existing literature, this review aims to provide insights to inform clinical practice and enhance patient care in this challenging clinical scenario. The methodology involved an extensive search of PubMed and Embase databases using specific keywords and terminology related to mortality, procedural outcomes, and postprocedural complications following PDA stent and APS in cyanotic congenital heart defects (CHD) patients. Six retrospective observational studies met the criteria, with 757 patients included. The analysis showed comparable mortality rates between PDA stents and APS. However, PDA stents were associated with decreased risks of mechanical circulatory support, postprocedural complications, and shorter hospital stays, mechanical ventilation, and intensive care unit stays compared to APS. Notably, patients with pulmonary atresia scheduled for biventricular surgery were more prevalent among those receiving PDA stents.  In conclusion, while the risk of mortality is similar between PDA stents and APS, PDA stents offer advantages such as shorter hospital stays and reduced complications. Patient characteristics also vary, with a higher prevalence of intact ventricular septum among those receiving PDA stents.


Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39(12):1890-900.

Khasawneh W, Hakim F, Abu Ras O, Hejazi Y, Abu-Aqoulah A. Incidence and Patterns of Congenital Heart Disease Among Jordanian Infants, a Cohort Study from a University Tertiary Center. Front Pediatr. 2020;8:219.

Kouatli A. Ductus arteriosus dependent congenital heart disease. Available at: 007002.pdf. Accessed on 07 April, 2024.

Khalil M, Jux C, Rueblinger L, Behrje J, Esmaeili A, Schranz D. Acute therapy of newborns with critical congenital heart disease. Transl Pediatr. 2019;8(2):114-26.

Sivakumar K, Bhagyavathy A, Coelho R, Satish R, Krishnan P. Longevity of neonatal ductal stenting for congenital heart diseases with duct-dependent pulmonary circulation. Congenit Heart Dis. 2012;7(6):526-33.

Akkinapally S, Hundalani SG, Kulkarni M, Fernandes CJ, Cabrera AG, Shivanna B, et al. Prostaglandin E1 for maintaining ductal patency in neonates with ductal-dependent cardiac lesions. Cochrane Database Syst Rev. 2018;2(2):CD011417.

Hussain A, Al-Zharani S, Muhammed AA, Al-Ata J, Galal OM. Midterm outcome of stent dilatation of patent ductus arteriosus in ductal-dependent pulmonary circulation. Congenit Heart Dis. 2008;3(4):241-9.

Petrucci O, O'Brien SM, Jacobs ML, Jacobs JP, Manning PB, Eghtesady P. Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure. Ann Thorac Surg. 2011;92(2):642-51.

Aggarwal V, Petit CJ, Glatz AC, Goldstein BH, Qureshi AM. Stenting of the ductus arteriosus for ductal‐dependent pulmonary blood flow‐current techniques and procedural considerations. Congenit Heart Dis. 2019;14:110-15.

Helal AM, Elmahrouk AF, Bekheet S, Barnawi HI, Jamjoom AA, Galal MO, Abou Zahr R. Patent ductus arteriosus stenting versus modified Blalock-Taussig shunt for palliation of duct-dependent pulmonary blood flow lesions. J Card Surg. 2022;37(9):2571-80.

Udink Ten Cate FE, Sreeram N, Hamza H, Agha H, Rosenthal E, Qureshi SA. Stenting the arterial duct in neonates and infants with congenital heart disease and duct‐dependent pulmonary blood flow: a multicenter experience of an evolving therapy over 18 years. Catheter Cardiovasc Interv. 2013;82:E233-43.

Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

Identifying publication bias in meta-analyses of continuous outcomes. Available at: Accessed on 07 April, 2024.

Amoozgar H, Cheriki S, Borzoee M, Ajami G, Soltani M, Ahmadipour M, et al. Short-term result of ductus arteriosus stent implantation compared with surgically created shunts. Pediatr Cardiol. 2012;33(8):1288-94.

Bentham JR, Zava NK, Harrison WJ, Shauq A, Kalantre A, Derrick G, et al. Duct stenting ver sus modified Blalock-Taussig shunt in neonates with duct-dependent pulmonary blood flow: associations with clinical outcomes in a multicenter National Study. Circulation. 2018;137(6):581-8.

Glatz AC, Petit CJ, Goldstein BH, Kelleman MS, McCracken CE, McDonnell A, et al. 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. Circulation. 2018;137(6):589-601.

Mallula K, Vaughn G, El‐Said H, Lamberti JJ, Moore JW. Comparison of ductal stenting versus surgical shunts for palliation of patients with pulmonary atresia and intact ventricular septum. Catheter Cardiovasc Interv. 2015;85(7):1196-202.

McMullan DM, Permut LC, Jones TK, Johnston TA, Rubio AE. Modified Blalock-Taussig shunt versus ductal stenting for palliation of cardiac lesions with inadequate pulmonary blood flow. J Thorac Cardiovasc Surg. 2014;147(1):397-401.

Santoro G, Capozzi G, Caianiello G, Palladino MT, Marrone C, Farina G, et al. Pulmonary artery growth after palliation of congenital heart disease with duct-dependent pulmonary circulation: arterial duct stenting versus surgical shunt. J Am Coll Cardiol. 2009;54(23):2180-6.

Goldstein BH, O’Byrne ML, Petit CJ, Qureshi AM, Dai D, Griffis HM, et al. Differences in cost of care by palliation strategy for infants with ductal-dependent pulmonary blood flow. Circ Cardiovasc Interv. 2019;12(4):e007232.

Alsagheir A, Koziarz A, Makhdoum A, Contreras J, Alraddadi H, Abdalla T, et al. Duct stenting versus modified Blalock-Taussig shunt in neonates and infants with duct-dependent pulmonary blood flow: a systematic review and meta-analysis. J Thorac Cardiovasc Surg. 2021;161(2):379-90.

Fakhry AbdelMassih A, Menshawey R, Menshawey E, El-Maghraby AE, Sabry AO, Kamel A, et al. Blalock-Taussig Shunt versus Ductal Stent in the Palliation of Duct Dependent Pulmonary Circulation; A Systematic Review and Metanalysis. Curr Probl Cardiol. 2022;47(9):100885.

Nasser BA, Abdulrahman M, Qwaee AAL, Alakfash A, Mohamad T, Kabbani MS. Impact of stent of ductus arteriosus and modified Blalock-Taussig shunt on pulmonary arteries growth and second-stage surgery in infants with ductus-dependent pulmonary circulation. J Saudi Heart Assoc. 2020;32(1):86-92.

Gorla SR, Singh AP. Pulmonary Atresia with Intact Ventricular Septum. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2024.