To compare outcomes of ductal stenting (DS) with those of modified Blalock-Taussig shunt (mBTS) as initial palliation in neonates with functionally univentricular heart and duct-dependent pulmonary blood flow, up to bidirectional cavopulmonary connection (BCPC).

We retrospectively analyzed 192 neonates with functionally univentricular heart and duct-dependent pulmonary blood flow undergoing initial palliation with DS (n=39) or mBTS (n=153) between 2005 and 2025, using Cox proportional hazards models.

The median follow-up was 6.3 months, including follow-up after BCPC. Low birth weight was more frequent in the DS group (28.2% vs 11.1%; P=.01). Survival after initial palliation, during the interstage period, and post-BCPC was 85.7% (95%CI, 81.9-91.5), 83.3% (95%CI, 76.9-88.1), and 79.7% (95%CI, 71.9-85.5), respectively, with no between-group differences (log-rank P >.8). Early postoperative morbidity, including neonatal intensive care unit length of stay, duration of inotropic support, and mechanical ventilation was greater after mBTS (all P=.01). Reintervention rates were similar between DS and mBTS (approximately 23% overall), with no difference in time to reintervention, even for unplanned procedures. Patients initially palliated with DS underwent BCPC earlier (5.3 [3.6-8.6] vs 7.3 [6.0-11.2] months; P=.05) and at lower body weight (5.9 [5.0-7.9] vs 6.9 [5.7-8.2] kg; P=.02). Branch pulmonary artery stenosis before BCPC was more frequent after mBTS (P=.01). After adjustment, overall mortality and reintervention before BCPC were numerically higher in the mBTS group, although these differences were not statistically significant.

DS provided safe and effective palliation and was associated with improved early postoperative recovery. Although mortality and reintervention before BCPC were numerically lower after DS, these differences were not statistically significant.