TY - JOUR
T1 - Comparison of Outcomes at Time of Superior Cavopulmonary Connection between Single Ventricle Patients with Ductal-Dependent Pulmonary Blood Flow Initially Palliated with Either Blalock-Taussig Shunt or Ductus Arteriosus Stent
T2 - Results from the Congenital Catheterization Research Collaborative
AU - Meadows, Jeffery J.
AU - Qureshi, Athar M.
AU - Goldstein, Bryan H.
AU - Petit, Christopher J.
AU - McCracken, Courtney E.
AU - Kelleman, Michael S.
AU - Aggarwal, Varun
AU - Bauser-Heaton, Holly
AU - Combs, Christine S.
AU - Gartenberg, Ari J.
AU - Ligon, R. Allen
AU - Nicholson, George T.
AU - Glatz, Andrew C.
N1 - Funding Information:
Financial support for this research was derived, in part, from the Kennedy Hammill Pediatric Cardiac Research Fund and the Liam Sexton Foundation.
Publisher Copyright:
© 2019 Lippincott Williams and Wilkins. All rights reserved.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background: Patients with single ventricle anatomy and ductal-dependent pulmonary blood flow may be initially palliated with either modified Blalock-Taussig shunt (BTS) or ductus arteriosus stent (DAS). Comparisons of outcomes during the interstage period and at the time of superior cavopulmonary connection (SCPC) are lacking and may differ between palliation strategies. Methods: Infants with single ventricle anatomy and ductal-dependent pulmonary blood flow palliated with either DAS or BTS from 2008 to 2015 were reviewed across 4 centers. Interstage outcomes, and for those who had SCPC, anatomy, hemodynamics, and perioperative clinical outcomes were compared. Thirty-five patients with DAS and 136 patients with BTS were included. Results: At initial palliation, demographic, clinical variables, and pulmonary artery size were similar. Interstage death, transplant, or unplanned reintervention to treat cyanosis occurred in 25.7% of DAS and 35.8% of BTS, P=0.27. Reintervention was more common with DAS (48.6% versus 2.2%; P<0.001). Twenty-three DAS patients and 111 BTS patients underwent SCPC. Preoperative hemodynamics and overall pulmonary artery growth were similar, although right pulmonary artery growth was better with DAS (change in z-score: 1.57 versus 0.65, P=0.026). SCPC intraoperative and postoperative courses were similar. Conclusions: In patients with single-ventricle anatomy and ductal-dependent pulmonary blood flow, interstage outcomes, hemodynamics before SCPC, and acute postoperative outcomes were similar. Overall reintervention was more common in the DAS group, driven by more frequent planned reintervention. Unplanned reintervention, death, and transplant were similar. Both groups demonstrated good pulmonary artery growth. DAS is a reasonable initial palliative alternative to BTS in select patients.
AB - Background: Patients with single ventricle anatomy and ductal-dependent pulmonary blood flow may be initially palliated with either modified Blalock-Taussig shunt (BTS) or ductus arteriosus stent (DAS). Comparisons of outcomes during the interstage period and at the time of superior cavopulmonary connection (SCPC) are lacking and may differ between palliation strategies. Methods: Infants with single ventricle anatomy and ductal-dependent pulmonary blood flow palliated with either DAS or BTS from 2008 to 2015 were reviewed across 4 centers. Interstage outcomes, and for those who had SCPC, anatomy, hemodynamics, and perioperative clinical outcomes were compared. Thirty-five patients with DAS and 136 patients with BTS were included. Results: At initial palliation, demographic, clinical variables, and pulmonary artery size were similar. Interstage death, transplant, or unplanned reintervention to treat cyanosis occurred in 25.7% of DAS and 35.8% of BTS, P=0.27. Reintervention was more common with DAS (48.6% versus 2.2%; P<0.001). Twenty-three DAS patients and 111 BTS patients underwent SCPC. Preoperative hemodynamics and overall pulmonary artery growth were similar, although right pulmonary artery growth was better with DAS (change in z-score: 1.57 versus 0.65, P=0.026). SCPC intraoperative and postoperative courses were similar. Conclusions: In patients with single-ventricle anatomy and ductal-dependent pulmonary blood flow, interstage outcomes, hemodynamics before SCPC, and acute postoperative outcomes were similar. Overall reintervention was more common in the DAS group, driven by more frequent planned reintervention. Unplanned reintervention, death, and transplant were similar. Both groups demonstrated good pulmonary artery growth. DAS is a reasonable initial palliative alternative to BTS in select patients.
KW - cardiac catheterization
KW - hemodynamics
KW - infant
KW - pulmonary artery
UR - http://www.scopus.com/inward/record.url?scp=85073169720&partnerID=8YFLogxK
U2 - 10.1161/CIRCINTERVENTIONS.119.008110
DO - 10.1161/CIRCINTERVENTIONS.119.008110
M3 - Article
C2 - 31607156
AN - SCOPUS:85073169720
SN - 1941-7640
VL - 12
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 10
M1 - e008110
ER -