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[Cyanotic congenital heart diseases duct dependent: Stent versus surgical shunt. Meta-analysis of observational studies].

BACKGROUND
The modified Blalock-Taussig shunt (mBTS) is the method of choice in the congenital heart disease duct dependent. More recently, the percutaneous implantation of a stent in the duct (PIS) has emerged as an alternative to the surgery.


OBJECTIVE
To determine the most safe and effective procedure by reading the available literature.


METHODS
A systematic review of observational studies was perfomed by searching Pubmed and SciVerse/Scopus, in which neonates were submitted to mBTS or PIS. Two independent reviewers selected the articles according to the inclusion criteria. The mortality rate was defined as the primary outcome. Complications and re-interventions were defined as secondary outcomes.


RESULTS
Twenty-three of 176 articles were included (n = 2243 patients, 1920 submitted to mBTS and 323 to PIS). The weighted average mortality rate of the neonates who underwent mBTS was 7,6% (95% CI: 6,5%-8,9 %) and submitted to IPS was 8.3% (95% CI: 4,6%-14,7%; p=0,7006). The weighted average rate of complications and re- interventions, weight and size of the stent and shunt did not show statistically significant differences. It was not possible to establish a relationship between these and mortality rate. Significant heterogeneity was detected for the mortality rate in the group undergoing PIS due to the different sample sizes, non-uniform patient selection and results with large confidence intervals.


CONCLUSIONS
We could not find systematic evidence to suggest that PIS is safer and more advantageous than the realization of a BTSm in these pathologies.