Abstract 14470: A Comparison Between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants With Ductal-dependent Pulmonary Blood Flow: Insights From a Multi-center Collaborative
Introduction: Infants with ductal dependent pulmonary blood flow (PBF) may undergo palliation with either ductus arteriosus stent (DAS) or Blalock-Taussig shunt (BTS). A balanced comparison of these two approaches has not been performed.
Methods: Consecutive infants with ductal dependent PBF and confluent pulmonary arteries palliated with either DAS or BTS from 1/08 to 11/15 were retrospectively reviewed from the 4 member centers of the Congenital Catheterization Research Collaborative. Primary outcome was defined as death or reintervention to treat cyanosis prior to any definitive repair or next staged palliation. Secondary outcomes included: intensive care unit (ICU) and hospital length of stay (LOS), diuretic use at discharge, and procedural complications. Outcomes were compared between treatment strategies using propensity score adjustment to account for baseline differences between groups.
Results: The cohort consisted of 105 DAS and 174 BTS patients. There were no differences in demographic and clinical characteristics. The groups differed in underlying anatomy (expected two-ventricle circulation in 63% of DAS v. 52% of BTS, p=0.08), and presence of antegrade PBF (65% of DAS v. 39% of BTS, p<0.001). The observed risk of the primary outcome was higher in the DAS group (48% v. 35%, p=0.04), due to a difference in risk of reintervention. There was no difference in risk of death (11.7% v. 14.1%, p=0.6). After propensity score adjustment, the risk of the primary outcome remained higher among the DAS group [OR=1.79 (95% CI: 1.01 - 3.17), p=0.045]. The DAS group had a lower adjusted ICU LOS [mean 4.5 (95% CI: 3.4 - 5.8) v. 9.4 (7.7 - 11.4) days, p<0.001] and risk of diuretic use at discharge [OR=0.34 (0.19 - 0.63), p<0.001]. There was no difference in adjusted hospital LOS. Procedural complications were lower in the DAS group (13.6% v. 26.2%, p=0.014).
Conclusions: This is the first multi-center comparison of palliative DAS and BTS for infants with ductal-dependent PBF, adjusted for patient factors to account for confounding by indication. Although there was a higher rate of reintervention to treat cyanosis, the ICU LOS was shorter, diuretic use was less, and procedural complications were lower in the DAS group, supporting DAS as a reasonable alternative to BTS.
Author Disclosures: A.C. Glatz: Research Grant; Significant; Children’s Heart Foundation. Consultant/Advisory Board; Modest; Bristol-Myers Squibb, Inc.. C.J. Petit: None. B.H. Goldstein: Consultant/Advisory Board; Modest; W.L. Gore, St. Jude, Braun Medical. M.S. Kelleman: None. C.E. McCracken: None. A. McDonnell: None. C. Mascio: None. S. Shashidharan: None. R. Ligon: None. J. Ao: None. W. Whiteside: None. W. Wellen: None. C.M. Metcalf: None. V. Aggarwal: None. H. Agrawal: None. J.S. Heinle: None. A.M. Qureshi: None.
- © 2016 by American Heart Association, Inc.