Comparison of ductal stent versus surgical shunt as initial intervention for neonates with pulmonary atresia with intact ventricular septum
Authors
Bao Nguyen Puente, Division of Cardiac Critical Care, Children's National Health System, 111 Michigan Ave NW M4800, Washington, DC, 20010, USA. bpuente@childrensnational.org.
Christopher W. Mastropietro, Division of Critical Care, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.
Saul Flores, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Eva W. Cheung, Division of Critical Care & Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.
Venugopal Amula, Division of Critical Care, Department of Pediatrics, University of Utah Health, Salt Lake City, UT, USA.
Monique Radman, Division of Critical Care, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
David Kwiatkowski, Division of Cardiology, Department of Pediatrics, Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USA.
Jason R. Buckley, Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
Kiona Allen, Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Rohit Loomba, Advocate Health - MidwestFollow
Karan Karki, Division of Cardiology, Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA.
Saurabh Chiwane, Division of Critical Care, Department of Pediatrics, Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, MO, USA.
Katherine Cashen, Division of Critical Care Medicine, Duke Children's Hospital, Duke University, Durham, NC, USA.
Kurt Piggott, Division of Pediatrics, Nemours Children's Hospital, Orlando, FL, USA.
Yamini Kapileshwarkar, Department of Pediatrics, Children's Hospital of Illinois, Peoria, IL, USA.
Keshava Murthy Gowda, Department of Pediatrics, Cleveland Clinic, Cleveland, OH, USA.
Aditya Badheka, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA.
Rahul Raman, Department of Pediatrics, Mercy Medical Center, Des Moines, IA, USA.
John M. Costello, Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
Huaiyu Zang, Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, OH, USA.
Ilias Iliopoulos, Department of Pediatrics, Inova Children's Hospital, Fairfax, VA, USA.
Recommended Citation
Puente BN, Mastropietro CW, Flores S, et al. Comparison of Ductal Stent Versus Surgical Shunt as Initial Intervention for Neonates with Pulmonary Atresia with Intact Ventricular Septum. Pediatr Cardiol. Published online June 6, 2024. doi:10.1007/s00246-024-03529-2
Abstract
Data comparing surgical systemic-to-pulmonary artery shunt and patent ductus arteriosus (PDA) stent as the initial palliation procedure for patients with pulmonary atresia with intact ventricular septum (PA-IVS) are limited. We sought to compare characteristics and outcomes in a multicenter cohort of patients with PA-IVS undergoing surgical shunts versus PDA stents. We retrospectively reviewed neonates with PA-IVS from 2009 to 2019 in 19 United States centers. Bivariate comparisons and multivariable logistic regression analysis were performed to determine the relationship between initial palliation strategy and outcomes including major adverse cardiovascular events (MACE): stroke, mechanical circulatory support, cardiac arrest, or death. 187 patients were included: 38 PDA stents and 149 surgical shunts. Baseline characteristics did not differ statistically between groups. Post-procedural MACE occurred in 4 patients (11%) with PDA stents versus 38 (26%) with surgical shunts, p = 0.079. Overall, the initial palliation strategy was not significantly associated with MACE (aOR:0.37; 95% CI,0.13-1.02). In patients with moderate-to-severe right ventricle hypoplasia, PDA stents were significantly associated with decreased odds of MACE (aOR:0.36; 95% CI,0.13-0.99). PDA stents were associated with lower vasoactive inotrope scores (median 0 versus 5, p < 0.001), greater likelihood to be extubated at the end of their procedure (37% versus 4%, p < 0.001), and shorter duration of mechanical ventilation (median 24 versus 96 h, p < 0.001). PDA stents were associated with significantly more unplanned reinterventions for hypoxemia compared to surgical shunts (42% vs. 20%, p = 0.009). In this multicenter study, neonates with PA-IVS who underwent PDA stenting received less vasoactive and ventilatory support postoperatively compared to those who had surgical shunts. Furthermore, patients with the most severe morphology had decreased odds of MACE.
Affiliations
Advocate Children's Hospital