Abstract 14104: Trends and Associated Outcomes in Neonates With Ductal-Dependent Cyanotic Congenital Heart Disease Undergoing Surgical Systemic-Pulmonary Artery Shunts versus Catheter-Based Ductal Stents From the Pediatric Health Information System Database

Abstract

Introduction: Neonates with ductal-dependent cyanotic congenital heart disease (CCHD) require palliation to establish stable pulmonary blood flow (PBF). Surgical systemic-to-pulmonary artery shunts have been the standard approach. More recently, catheter-based ductal stents have been performed as an alternative less invasive intervention. We aimed to characterize recent trends in the utilization of surgical shunts versus ductal stents and compare associated outcomes. Methods: Using data from the Pediatric Health Information System, we retrospectively analyzed neonates with CCHD who underwent surgical shunt or ductal stent placement to establish stable PBF between January 2016 and December 2021. Neonates with CCHD with ductal-dependent PBF were identified by ICD-10 diagnosis codes and stratified by surgical shunt or ductal stent using ICD-10 procedure codes. The primary outcome was post-intervention length of stay (LOS). Secondary outcomes were rate of reintervention on the ductal stent, surgical shunt, atrial septum, right ventricular outflow tract, or branch pulmonary arteries and adjusted hospital charges per admission. Results: Of the 931 patients included, 65.4% underwent a surgical shunt over the 5-year period. The proportion who underwent a ductal stent increased from 18.9% to 53.5% from 2016 to 2021. There was no significant difference in mortality (surgical shunt 6.1% vs ductal stent 4.4%, P=0.27). The median adjusted difference in LOS was 11 days greater for the surgical shunt cohort (95% CI: 8.5-13.5, P<0.001). The likelihood of reintervention was significantly greater in the ductal stent group (30 days: adjusted OR=2.19, 95% CI: 1.02-4.71, P=0.044; 3 months: adjusted OR=4.85, 95% CI: 3.13-7.52, P<0.011). Median adjusted total hospital charges were $572,400 (367,600-967,900) versus $302,500 (214,000-523,000) for the surgical shunt and ductal stent groups, respectively (P<0.001). Conclusions: Ductal stenting has become an increasingly utilized palliative approach to secure PBF in neonates with CCHD across various centers in the United States. Ductal stenting is associated with decreased LOS and reduced overall charges for the index hospitalization but also with a greater reintervention rate than surgical shunting.