TY - JOUR
T1 - Palliation Strategy to Achieve Complete Repair in Symptomatic Neonates with Tetralogy of Fallot
AU - The Congenital Cardiac Research Collaborative (CCRC) Investigators
AU - Law, Mark A.
AU - Glatz, Andrew C.
AU - Romano, Jennifer C.
AU - Chai, Paul J.
AU - Mascio, Christopher E.
AU - Petit, Christopher J.
AU - McCracken, Courtney E.
AU - Kelleman, Michael S.
AU - Nicholson, George T.
AU - Meadows, Jeffery J.
AU - Zampi, Jeffrey D.
AU - Shahanavaz, Shabana
AU - Batlivala, Sarosh P.
AU - Pettus, Joelle
AU - Pajk, Amy L.
AU - Hock, Kristal M.
AU - Goldstein, Bryan H.
AU - Qureshi, Athar M.
AU - Eilers, Lindsay F.
AU - Khan, Hala Q.
AU - Smith, Justin D.
AU - Asztalos, Ivor B.
AU - Kamsheh, Alicia M.
AU - Ligon, R. Allen
AU - Juma, Sarina
AU - Juergensen, Stephan
AU - Rinderknecht, Fatuma Ayann
AU - Merritt, Taylor C.
AU - Candor, Matthew
AU - Healan, Steven J.
N1 - Funding Information:
Funding for this project was provided by the author’s respective institutions and in part by the generous support from the member institutions of the collaborative as well as the Kennedy Hammill Pediatric Cardiac Research Fund, The Liam Sexton Foundation, and A Heart Like Ava. Dr. Goldstein receives consulting fees from Medtronic, W.L. Gore & Associates, Mezzion Pharma and PECA labs.
Funding Information:
We thank Joelle Pettus for her tireless efforts in the management of the Congenital Cardiac Research Collaborative. The collaborative acknowledges and would like to thank the Children’s Healthcare of Atlanta and Emory University Pediatrics Biostatics Collaboration Core for their continued expertise and support. The Congenital Cardiac Research Collaborative Investigators Collaborators include Lindsay F. Eilers, MD, and Hala Q. Khan, BSc (The Lillie Frank Abercrombie Section of Cardiology, Texas Children’s Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, TX); Justin D. Smith (C.S. Mott Children’s Hospital, Ann Arbor, MI); Ivor B. Asztalos, MD, MSCE, and Alicia M. Kamsheh, MD (Children’s Hospital of Philadelphia, Philadelphia, PA); R. Allen Ligon, MD, and Sarina Juma, MPH, (Children’s Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA); Stephan Juergensen, MD, and Fatuma Ayann Rinderknecht, BA, (University of California, San Francisco, San Francisco, CA); Taylor C Merritt RN BSN, and Matthew Candor MET (St Louis Children’s Hospital, St. Louis, MO); Amy L Pajk, MBA, CCRP (Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH); Steven J. Healan, MD, MSCI, (Division of Cardiology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville TN).
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2022/10
Y1 - 2022/10
N2 - Neonates with symptomatic tetralogy of Fallot (sTOF) may undergo palliations with varying physiology, namely systemic to pulmonary artery connections (SPC) or right ventricular outflow tract interventions (RVOTI). A comparison of palliative strategies based on the physiology created is lacking. Consecutive sTOF neonates undergoing SPC or RVOTI from 2005–2017 were reviewed from the Congenital Cardiac Research Collaborative. The primary outcome was survival with successful complete repair (CR) by 18 months. A variety of secondary outcomes were assessed including overall survival, hospitalization-related comorbidities, and interstage reinterventions. Propensity score adjustment was utilized to compare treatment strategies. The cohort included 252 SPC (surgical shunt = 226, ductus arteriosus stent = 26) and 68 RVOTI (balloon pulmonary valvuloplasty = 48, RVOT stent = 11, RVOT patch = 9) patients. Genetic syndrome (29 [42.6%] v 75 [29.8%], p = 0.04), weight < 2.5 kg (28 [41.2%] v 68 [27.0%], p = 0.023), bilateral pulmonary artery Z-score < − 2 (19 [28.0%] v 36 [14.3%], p = 0.008), and pre-intervention antegrade flow (48 [70.6%] v 104 [41.3%], p < 0.001) were more common in RVOTI. Significant center differences were noted (p < 0.001). Adjusted survival to CR by 18 months (HR = 0.87, 95% CI = 0.63–1.21, p = 0.41) and overall survival (HR = 2.08, 95% CI = 0.93–4.65, p = 0.074) were similar. RVOTI had increased interstage reintervention (HR = 2.15, 95% CI = 1.36–3.99, p = 0.001). Total anesthesia (243 [213, 277] v 328 [308, 351] minutes, p < 0.001) and cardiopulmonary bypass times (117 [103, 132] v 151 [143, 160] minutes, p < 0.001) favored RVOTI. In this multicenter comparison of physiologic palliation strategies for sTOF, survival to successful CR and overall survival were similar; however, reintervention burden was significantly higher in RVOTI.
AB - Neonates with symptomatic tetralogy of Fallot (sTOF) may undergo palliations with varying physiology, namely systemic to pulmonary artery connections (SPC) or right ventricular outflow tract interventions (RVOTI). A comparison of palliative strategies based on the physiology created is lacking. Consecutive sTOF neonates undergoing SPC or RVOTI from 2005–2017 were reviewed from the Congenital Cardiac Research Collaborative. The primary outcome was survival with successful complete repair (CR) by 18 months. A variety of secondary outcomes were assessed including overall survival, hospitalization-related comorbidities, and interstage reinterventions. Propensity score adjustment was utilized to compare treatment strategies. The cohort included 252 SPC (surgical shunt = 226, ductus arteriosus stent = 26) and 68 RVOTI (balloon pulmonary valvuloplasty = 48, RVOT stent = 11, RVOT patch = 9) patients. Genetic syndrome (29 [42.6%] v 75 [29.8%], p = 0.04), weight < 2.5 kg (28 [41.2%] v 68 [27.0%], p = 0.023), bilateral pulmonary artery Z-score < − 2 (19 [28.0%] v 36 [14.3%], p = 0.008), and pre-intervention antegrade flow (48 [70.6%] v 104 [41.3%], p < 0.001) were more common in RVOTI. Significant center differences were noted (p < 0.001). Adjusted survival to CR by 18 months (HR = 0.87, 95% CI = 0.63–1.21, p = 0.41) and overall survival (HR = 2.08, 95% CI = 0.93–4.65, p = 0.074) were similar. RVOTI had increased interstage reintervention (HR = 2.15, 95% CI = 1.36–3.99, p = 0.001). Total anesthesia (243 [213, 277] v 328 [308, 351] minutes, p < 0.001) and cardiopulmonary bypass times (117 [103, 132] v 151 [143, 160] minutes, p < 0.001) favored RVOTI. In this multicenter comparison of physiologic palliation strategies for sTOF, survival to successful CR and overall survival were similar; however, reintervention burden was significantly higher in RVOTI.
KW - Blalock–Taussig–Thomas Shunt
KW - Congenital heart disease
KW - Right ventricle outflow tract intervention
KW - Tetralogy of Fallot
UR - http://www.scopus.com/inward/record.url?scp=85138459630&partnerID=8YFLogxK
U2 - 10.1007/s00246-022-02886-0
DO - 10.1007/s00246-022-02886-0
M3 - Article
C2 - 35381860
AN - SCOPUS:85138459630
SN - 0172-0643
VL - 43
SP - 1587
EP - 1598
JO - Pediatric Cardiology
JF - Pediatric Cardiology
IS - 7
ER -