Comparing surgical shunting with transcatheter stenting for initial palliation of cyanotic tetralogy of fallot: An inverse probability treatment weighting study

To compare surgical shunting with transcatheter stenting for initial palliation of cyanotic tetralogy of Fallot, including high-risk infants. This retrospective two-center study included 101 infants who underwent palliation before 1 year of age, including 76 who underwent surgical shunting and 25 who underwent transcatheter stenting. Outcomes were evaluated using stabilized inverse probability of treatment weighting with doubly robust adjustment. The primary composite outcome was death, cardiopulmonary resuscitation, or extracorporeal membrane oxygenation. Secondary outcomes included recovery, reintervention, medical expenses, and pulmonary artery (PA) development. After adjustment, the primary composite outcome and overall perioperative complication rate did not differ significantly between groups. Surgical shunting was associated with longer log-transformed intubation duration (β = 0.948, 95% CI 0.203-1.693; P = 0.013), intensive care unit stay (β = 0.584, 95% CI 0.050-1.118; P = 0.032), and hospital stay (β = 0.558, 95% CI 0.071-1.046; P = 0.025), but lower odds of reintervention (OR = 0.112, 95% CI 0.033-0.379; P < 0.001). In high-risk patients, surgical shunting was associated with more perioperative complications (OR = 7.712, 95% CI 1.569-37.913; P = 0.013), higher medical expenses, and lower McGoon and PA symmetry indices at total correction. No significant between-group differences were observed in the primary composite outcome or overall perioperative complication rate. Transcatheter stenting was associated with faster recovery but more frequent reintervention. Among high-risk infants, it was associated with fewer perioperative complications, lower index hospitalization expenses, and more favorable PA development. The Research Ethics Committee of National Taiwan University Hospital (No. 202602073RIND), waived informed consent.