The Battle of the Shunts: A Systematic Review and Meta-Analysis of Cryopreserved and Antibiotic-Preserved Saphenous Vein Homografts Versus Polytetrafluoroethylene Grafts for Systemic-to-Pulmonary Artery Shunts in Pediatric Patients

This study compared two types of conduits used for systemic-to-pulmonary artery shunts in children with congenital heart disease: synthetic polytetrafluoroethylene (PTFE) grafts and biological saphenous vein homografts (SVH). Across 16 studies including 684 patients, SVH was associated with significantly less early shunt thrombosis than PTFE (RR 0.29; 95 percent confidence interval [CI]: 0.08–0.96), with no differences in overall mortality, infection, or catheter-based reintervention. Single-arm data showed similar early mortality (SVH 9 percent versus PTFE 11 percent) and stenosis (both 8 percent). Although SVH appears safer regarding thrombosis, the GRADE certainty of evidence was very low to low, highlighting the need for large, multicenter randomized trials.