Comparative outcomes of pulmonary artery changes in ductal-patency-dependent pulmonary circulation: Patent ductus arteriosus stent versus modified Blalock–Taussig shunt
- 1Pediatric Heart Center, Queen Sirikit National Institute of Child Health, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand
- 2Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- 3Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Abstract
Background: Neonates with ductal-dependent pulmonary blood flow (DP-PBF) require timely palliation to maintain pulmonary perfusion. Patent ductus arteriosus (PDA) stenting has emerged as a less invasive alternative to modified Blalock–Taussig shunt (mBTS), but comparative data on longitudinal pulmonary artery growth and clinical outcomes remain limited. Methods: This multicenter retrospective cohort study included infants with DP-PBF who underwent PDA stenting or mBTS as first-stage palliation at Queen Sirikit National Institute of Child Health and Songklanagarind Hospital, Thailand, between January 2017 and December 2022. Pulmonary artery growth was assessed using the McGoon ratio and Nakata index at baseline, 2 months, and 12 months. Longitudinal changes were analyzed using linear mixed-effects models with adjustment for ventricular physiology. Procedural complications were compared, and mortality was evaluated using Kaplan–Meier analysis, Cox regression, and 12-month restricted mean survival time. Results: Eighty-six infants were included: 41 underwent PDA stenting and 45 underwent mBTS. Baseline pulmonary artery measurements were comparable, although diagnostic composition differed between groups. At 2 months, PDA stenting was associated with greater pulmonary artery growth than mBTS, with a higher McGoon ratio (mean difference, 0.18; 95% CI, 0.05–0.31; p = 0.005) and Nakata index (mean difference, 51.2 mm2/m2; 95% CI, 23.0–79.5; p < 0.001). By 12 months, the Nakata index was similar between groups (p = 0.90), whereas a statistically significant between-group difference in McGoon ratio remained (mean difference, 0.15; 95% CI, 0.02–0.29; p = 0.028). Procedural complications were less frequent after PDA stenting than after mBTS (17.1% vs 57.8%; risk ratio for mBTS vs PDA stenting, 3.38; 95% CI, 1.65–6.95; p = 0.001). Although mortality was numerically lower after PDA stenting, time-to-event analyses did not show a statistically significant survival difference. Conclusions: In this cohort, PDA stenting was associated with greater early pulmonary artery growth and fewer observed procedural complications compared with mBTS. By 12 months, the Nakata index was similar between groups, whereas a statistically significant difference in McGoon ratio remained. These findings should be interpreted cautiously because of non-randomized treatment allocation, differences in diagnostic composition, and potential residual confounding.
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BibTeX
@article{patrakunwiwat2026comparative,
title = {{Comparative outcomes of pulmonary artery changes in ductal-patency-dependent pulmonary circulation: Patent ductus arteriosus stent versus modified Blalock–Taussig shunt}},
author = {Panthip Patrakunwiwat and Kraiwat Pattharasripong and Kanjarut Wongwaitaweewong and Supaporn Roymanee and Worakan Promphan and Jirayut Jarutach and Rujira Buntharikpornpun and Pongsanae Duangpakdee and Pimpak Prachasilchai and Suppalak Puttharak},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0358266},
url = {https://doi.org/10.1371/journal.pone.0358266},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Comparative outcomes of pulmonary artery changes in ductal-patency-dependent pulmonary circulation: Patent ductus arteriosus stent versus modified Blalock–Taussig shunt
AU - Panthip Patrakunwiwat
AU - Kraiwat Pattharasripong
AU - Kanjarut Wongwaitaweewong
AU - Supaporn Roymanee
AU - Worakan Promphan
AU - Jirayut Jarutach
AU - Rujira Buntharikpornpun
AU - Pongsanae Duangpakdee
AU - Pimpak Prachasilchai
AU - Suppalak Puttharak
PY - 2026
DA - 2026/09/15
JO - PLOS One
DO - 10.1371/journal.pone.0358266
UR - https://doi.org/10.1371/journal.pone.0358266
AB - Background: Neonates with ductal-dependent pulmonary blood flow (DP-PBF) require timely palliation to maintain pulmonary perfusion. Patent ductus arteriosus (PDA) stenting has emerged as a less invasive alternative to modified Blalock–Taussig shunt (mBTS), but comparative data on longitudinal pulmonary artery growth and clinical outcomes remain limited. Methods: This multicenter retrospective cohort study included infants with DP-PBF who underwent PDA stenting or mBTS as first-stage palliation at Queen Sirikit National Institute of Child Health and Songklanagarind Hospital, Thailand, between January 2017 and December 2022. Pulmonary artery growth was assessed using the McGoon ratio and Nakata index at baseline, 2 months, and 12 months. Longitudinal changes were analyzed using linear mixed-effects models with adjustment for ventricular physiology. Procedural complications were compared, and mortality was evaluated using Kaplan–Meier analysis, Cox regression, and 12-month restricted mean survival time. Results: Eighty-six infants were included: 41 underwent PDA stenting and 45 underwent mBTS. Baseline pulmonary artery measurements were comparable, although diagnostic composition differed between groups. At 2 months, PDA stenting was associated with greater pulmonary artery growth than mBTS, with a higher McGoon ratio (mean difference, 0.18; 95% CI, 0.05–0.31; p = 0.005) and Nakata index (mean difference, 51.2 mm2/m2; 95% CI, 23.0–79.5; p < 0.001). By 12 months, the Nakata index was similar between groups (p = 0.90), whereas a statistically significant between-group difference in McGoon ratio remained (mean difference, 0.15; 95% CI, 0.02–0.29; p = 0.028). Procedural complications were less frequent after PDA stenting than after mBTS (17.1% vs 57.8%; risk ratio for mBTS vs PDA stenting, 3.38; 95% CI, 1.65–6.95; p = 0.001). Although mortality was numerically lower after PDA stenting, time-to-event analyses did not show a statistically significant survival difference. Conclusions: In this cohort, PDA stenting was associated with greater early pulmonary artery growth and fewer observed procedural complications compared with mBTS. By 12 months, the Nakata index was similar between groups, whereas a statistically significant difference in McGoon ratio remained. These findings should be interpreted cautiously because of non-randomized treatment allocation, differences in diagnostic composition, and potential residual confounding.
SN - 1932-6203
ER -