Abstract 16867: Comparison of Ductal Arteriosus Stent and Blalock-Taussig Shunt as Palliation for Neonates With Sole Source Ductal-Dependent Pulmonary Blood Flow: Results From the Congenital Catheterization Research Collaborative

Abstract

Introduction: Ductus arteriosus stenting (DAS) is an accepted method for securing pulmonary blood flow in cyanotic neonates. However, in neonates with pulmonary atresia and single source ductal-dependent pulmonary blood flow (SSPBF), DAS remains controversial. Published outcomes in this population are limited. We sought to evaluate outcomes in neonates with SSPBF pts, comparing DAS and surgical Blalock-Taussig shunt (BTS). Methods: Neonates with SSPBF who underwent DAS or BTS from four centers of the Congenital Catheterization Research Collaborative from January 2008 to December 2015 were retrospectively reviewed. Peri-procedural complications, reintervention prior to ultimate surgical repair, pulmonary artery (PA) diameter and interval growth were compared using available imaging studies. A propensity score was utilized to compare cohorts adjusted for differences in patient factors. Results: Forty patients with DAS and 157 patients with BTS were included. At palliation, the DAS and BTS cohorts had similar age, weight, and expected ultimate physiology. Rates of procedural complications following BTS and DAS were also similar. Following initial palliation, DAS patients were less likely to be treated with inotropes (p <0.01) or diuretics (p = 0.046). Both groups had similar median lengths of hospital stay DAS 19 days (9-38), BTS 13 (10-23), p=0.19 and rates of unplanned reinterventions (17.5% of DAS and 21% in BTS, p= 0.62). Pre-palliation PA diameter was smaller (p=0.02), and PA symmetry was lower (p=0.02) in the DAS cohort. However, by time of definitive repair there was no difference in PA symmetry (0.80 in DAS cohort vs 0.82 in BTS cohort, p=0.64), in PA diameter (Nakata 161mm 2 /m 2 (137-166) in DAS vs 152mm 2 /m2 (94-227) in BTS, p=0.62) or in PA growth (change in Nakata 51mm 2 /m 2 (-21-61) in DAS vs 24mm 2 /m 2 (-28-131) in BTS, p=0.79). Rates of PA plasty and post-repair PA interventions did not differ between the cohorts. Conclusions: In neonates with SSPBF, DAS and BTS appear to have equivalent outcomes post-palliation and at time of subsequent surgical repair. Despite concerns about DAS in SSPBF, it appears to be a durable approach with unchanged PA growth compared to BTS.