Author + information
- Allen Ligona,b,
- Christopher Petita,b,
- Mike Kellemana,b,
- Nikhil Chanania,b,
- Robert Vincenta,b and
- Dennis Kima,b
Background: Stenting of the ductus arteriosus is an effective alternative in establishing stable pulmonary blood flow (PBF) in infants with cyanotic congenital heart disease. We performed a retrospective comparison between surgical shunts (SS) and ductal stents (DS) at our institution.
Methods: We reviewed all SS or DS patients from June 2012 to May 2016 who were considered equivalent candidates for either palliation. Patients who received a SS due to additional anatomic issues were not included. We compared baseline patient characteristics, re-intervention rates and post-operative outcomes including feeding patterns on discharge, somatic growth velocity after discharge and effects on the subsequent surgical intervention.
Results: Of 107 total patients (66 SS and 41 DS), there were no baseline differences between the groups prior to intervention or with respect to single vs dual source PBF lesions. In the DS group there were fewer mechanical ventilator days post-procedure (median 1 vs 4; p<0.01), inotrope utilization days (0 vs 3; p<0.01), diuretic usage days (8 vs 12; p<0.01), and ICU days (2 vs 8; p<0.01). The SS had a higher incidence of need for ECMO (18.2% vs 2.4%; p=0.02). The DS group had more patients discharged solely on oral feeds (43.9% vs 3.0%; p<0.01) and with fewer patients on strict nasogastric feeds (22% vs 53%; p<0.01). The DS cohort experienced a greater somatic growth velocity in the interval until the subsequent surgical palliation (21.9 vs 19.6 grams/day; p<0.01). The rate of catheterizations without intervention were higher in the SS (p=0.031). There was no difference between the groups in regards to catheterizations with interventions (p=0.63), overall length of stay (p=0.45), readmission within 30 days (p=0.13), pulmonary arterial augmentation (p=0.39) or age (p=0.92) at subsequent surgery.
Conclusions: At our institution, the introduction of a ductal stenting has been associated with reduced morbidity and improved post-procedural outcomes. These benefits continue to the time of next surgical intervention. Evaluation of these outcomes has resulted in a “cultural shift” in strategy for many patients who otherwise would have received a surgical shunt a priori.
Room 146 C
Sunday, March 19, 2017, 8:25 a.m.-8:35 a.m.
Session Title: Highlighted Original Research: Congenital Heart Disease and the Year in Review
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 908-06
- 2017 American College of Cardiology Foundation