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 - 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 -