Author + information
- Matthew William Buelowa,b,
- Nancy Rudda,b,
- Jena Tanema,b,
- Pippa Simpsona,b,
- Peter Bartza,b and
- Garick Hilla,b
Background: Single ventricle heart disease with aortic arch hypoplasia has high morbidity and mortality, with the greatest risk seen in the interstage period. Residual lesions often require catheter based or surgical re-intervention to minimize risk. We sought to describe the types, frequency, and risk factors for re-intervention, between stage 1 palliation and stage 2 palliation, utilizing the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) database.
Methods: The NPC-QIC database, consisting of patients discharged home after stage 1 palliation from 53 centers in the United States, was queried. The primary risk factor of interest was shunt type and the primary outcome was re-intervention.
Results: Of the 1156 patients, 580 patients (50.2%) had a re-intervention. There was no difference in total rate of re-intervention between those with a modified BT shunt (MBTS)(52.5%) and those with an RV-PA shunt (RVPAS)(48%, p=0.17). The MBTS group had increased re-intervention during stage 1 hospitalization (23% vs 16%; OR: 1.6 (95% CI: 1.2-2.2), p=0.002). Those with a MBTS underwent aortic arch re-intervention more frequently than those with an RVPAS (p<0.005), while patients with an RVPAS had increased re-intervention on the shunt and the pulmonary arteries (p=0.02) following discharge. Post operative mechanical ventilation > 14 days (p<0.01) was the only risk factor associated with re-intervention by multivariable analysis, regardless of shunt type.
Conclusions: Re-intervention between stage I and stage 2 palliation is common. There is no difference in the total frequency of re-intervention between patients with a MBTS and an RVPAS, though the types and timing of re-intervention did vary between shunt types. Longitudinal assessment of the NPC-QIC database will be important to identify long term outcomes of patients requiring re-intervention.
Room 146 C
Sunday, March 19, 2017, 9:17 a.m.-9:27 a.m.
Session Title: Highlighted Original Research: Congenital Heart Disease and the Year in Review
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 908-14
- 2017 American College of Cardiology Foundation