Comparison between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants with Ductal-Dependent Pulmonary Blood Flow: Insights from the Congenital Catheterization Research Collaborative

Andrew C. Glatz, Christopher J. Petit, Bryan H. Goldstein, Michael S. Kelleman, Courtney E. McCracken, Alicia McDonnell, Timothy Buckey, Christopher E. Mascio, Subi Shashidharan, R. Allen Ligon, Jingning Ao, Wendy Whiteside, W. Jack Wallen, Christina M. Metcalf, Varun Aggarwal, Hitesh Agrawal, Athar M. Qureshi

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Infants with ductal-dependent pulmonary blood flow may undergo palliation with either a patent ductus arteriosus (PDA) stent or a modified Blalock-Taussig (BT) shunt. A balanced multicenter comparison of these 2 approaches is lacking. Methods: Infants with ductal-dependent pulmonary blood flow palliated with either a PDA stent or a BT shunt from January 2008 to November 2015 were reviewed from the 4 member centers of the Congenital Catheterization Research Collaborative. Outcomes were compared by use of propensity score adjustment to account for baseline differences between groups. Results: One hundred six patients with a PDA stent and 251 patients with a BT shunt were included. The groups differed in underlying anatomy (expected 2-ventricle circulation in 60% of PDA stents versus 45% of BT shunts; P=0.001) and presence of antegrade pulmonary blood flow (61% of PDA stents versus 38% of BT shunts; P<0.001). After propensity score adjustment, there was no difference in the hazard of the primary composite outcome of death or unplanned reintervention to treat cyanosis (hazard ratio, 0.8; 95% confidence interval [CI], 0.52-1.23; P=0.31). Other reinterventions were more common in the PDA stent group (hazard ratio, 29.8; 95% CI, 9.8-91.1; P<0.001). However, the PDA stent group had a lower adjusted intensive care unit length of stay (5.3 days [95% CI, 4.2-6.7] versus 9.19 days [95% CI, 7.9-10.6]; P<0.001), a lower risk of diuretic use at discharge (odds ratio, 0.4; 95% CI, 0.25-0.64; P<0.001) and procedural complications (odds ratio, 0.4; 95% CI, 0.2-0.77; P=0.006), and larger (152 mm 2 /m 2 [95% CI, 132-176] versus 125 mm 2 /m 2 [95% CI, 113-138]; P=0.029) and more symmetrical (symmetry index, 0.84 [95% CI, 0.8-0.89] versus 0.77 [95% CI, 0.75-0.8]; P=0.008] pulmonary arteries at the time of subsequent surgical repair or last follow-up. Conclusions: In this multicenter comparison of palliative PDA stent and BT shunt for infants with ductal-dependent pulmonary blood flow adjusted for differences in patient factors, there was no difference in the primary end point, death or unplanned reintervention to treat cyanosis. However, other markers of morbidity and pulmonary artery size favored the PDA stent group, supporting PDA stent as a reasonable alternative to BT shunt in select patients.

Original languageEnglish (US)
Pages (from-to)589-601
Number of pages13
JournalCirculation
Volume137
Issue number6
DOIs
StatePublished - Feb 6 2018

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Blalock-Taussig Procedure
Patent Ductus Arteriosus
Catheterization
Stents
Confidence Intervals
Lung
Research
Propensity Score
Cyanosis
Pulmonary Artery
Odds Ratio
Diuretics
Intensive Care Units
Length of Stay
Anatomy

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Comparison between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants with Ductal-Dependent Pulmonary Blood Flow : Insights from the Congenital Catheterization Research Collaborative. / Glatz, Andrew C.; Petit, Christopher J.; Goldstein, Bryan H.; Kelleman, Michael S.; McCracken, Courtney E.; McDonnell, Alicia; Buckey, Timothy; Mascio, Christopher E.; Shashidharan, Subi; Ligon, R. Allen; Ao, Jingning; Whiteside, Wendy; Wallen, W. Jack; Metcalf, Christina M.; Aggarwal, Varun; Agrawal, Hitesh; Qureshi, Athar M.

In: Circulation, Vol. 137, No. 6, 06.02.2018, p. 589-601.

Research output: Contribution to journalArticle

Glatz, AC, Petit, CJ, Goldstein, BH, Kelleman, MS, McCracken, CE, McDonnell, A, Buckey, T, Mascio, CE, Shashidharan, S, Ligon, RA, Ao, J, Whiteside, W, Wallen, WJ, Metcalf, CM, Aggarwal, V, Agrawal, H & Qureshi, AM 2018, 'Comparison between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants with Ductal-Dependent Pulmonary Blood Flow: Insights from the Congenital Catheterization Research Collaborative', Circulation, vol. 137, no. 6, pp. 589-601. https://doi.org/10.1161/CIRCULATIONAHA.117.029987
Glatz, Andrew C. ; Petit, Christopher J. ; Goldstein, Bryan H. ; Kelleman, Michael S. ; McCracken, Courtney E. ; McDonnell, Alicia ; Buckey, Timothy ; Mascio, Christopher E. ; Shashidharan, Subi ; Ligon, R. Allen ; Ao, Jingning ; Whiteside, Wendy ; Wallen, W. Jack ; Metcalf, Christina M. ; Aggarwal, Varun ; Agrawal, Hitesh ; Qureshi, Athar M. / Comparison between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants with Ductal-Dependent Pulmonary Blood Flow : Insights from the Congenital Catheterization Research Collaborative. In: Circulation. 2018 ; Vol. 137, No. 6. pp. 589-601.
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abstract = "Background: Infants with ductal-dependent pulmonary blood flow may undergo palliation with either a patent ductus arteriosus (PDA) stent or a modified Blalock-Taussig (BT) shunt. A balanced multicenter comparison of these 2 approaches is lacking. Methods: Infants with ductal-dependent pulmonary blood flow palliated with either a PDA stent or a BT shunt from January 2008 to November 2015 were reviewed from the 4 member centers of the Congenital Catheterization Research Collaborative. Outcomes were compared by use of propensity score adjustment to account for baseline differences between groups. Results: One hundred six patients with a PDA stent and 251 patients with a BT shunt were included. The groups differed in underlying anatomy (expected 2-ventricle circulation in 60{\%} of PDA stents versus 45{\%} of BT shunts; P=0.001) and presence of antegrade pulmonary blood flow (61{\%} of PDA stents versus 38{\%} of BT shunts; P<0.001). After propensity score adjustment, there was no difference in the hazard of the primary composite outcome of death or unplanned reintervention to treat cyanosis (hazard ratio, 0.8; 95{\%} confidence interval [CI], 0.52-1.23; P=0.31). Other reinterventions were more common in the PDA stent group (hazard ratio, 29.8; 95{\%} CI, 9.8-91.1; P<0.001). However, the PDA stent group had a lower adjusted intensive care unit length of stay (5.3 days [95{\%} CI, 4.2-6.7] versus 9.19 days [95{\%} CI, 7.9-10.6]; P<0.001), a lower risk of diuretic use at discharge (odds ratio, 0.4; 95{\%} CI, 0.25-0.64; P<0.001) and procedural complications (odds ratio, 0.4; 95{\%} CI, 0.2-0.77; P=0.006), and larger (152 mm 2 /m 2 [95{\%} CI, 132-176] versus 125 mm 2 /m 2 [95{\%} CI, 113-138]; P=0.029) and more symmetrical (symmetry index, 0.84 [95{\%} CI, 0.8-0.89] versus 0.77 [95{\%} CI, 0.75-0.8]; P=0.008] pulmonary arteries at the time of subsequent surgical repair or last follow-up. Conclusions: In this multicenter comparison of palliative PDA stent and BT shunt for infants with ductal-dependent pulmonary blood flow adjusted for differences in patient factors, there was no difference in the primary end point, death or unplanned reintervention to treat cyanosis. However, other markers of morbidity and pulmonary artery size favored the PDA stent group, supporting PDA stent as a reasonable alternative to BT shunt in select patients.",
author = "Glatz, {Andrew C.} and Petit, {Christopher J.} and Goldstein, {Bryan H.} and Kelleman, {Michael S.} and McCracken, {Courtney E.} and Alicia McDonnell and Timothy Buckey and Mascio, {Christopher E.} and Subi Shashidharan and Ligon, {R. Allen} and Jingning Ao and Wendy Whiteside and Wallen, {W. Jack} and Metcalf, {Christina M.} and Varun Aggarwal and Hitesh Agrawal and Qureshi, {Athar M.}",
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TY - JOUR

T1 - Comparison between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants with Ductal-Dependent Pulmonary Blood Flow

T2 - Insights from the Congenital Catheterization Research Collaborative

AU - Glatz, Andrew C.

AU - Petit, Christopher J.

AU - Goldstein, Bryan H.

AU - Kelleman, Michael S.

AU - McCracken, Courtney E.

AU - McDonnell, Alicia

AU - Buckey, Timothy

AU - Mascio, Christopher E.

AU - Shashidharan, Subi

AU - Ligon, R. Allen

AU - Ao, Jingning

AU - Whiteside, Wendy

AU - Wallen, W. Jack

AU - Metcalf, Christina M.

AU - Aggarwal, Varun

AU - Agrawal, Hitesh

AU - Qureshi, Athar M.

PY - 2018/2/6

Y1 - 2018/2/6

N2 - Background: Infants with ductal-dependent pulmonary blood flow may undergo palliation with either a patent ductus arteriosus (PDA) stent or a modified Blalock-Taussig (BT) shunt. A balanced multicenter comparison of these 2 approaches is lacking. Methods: Infants with ductal-dependent pulmonary blood flow palliated with either a PDA stent or a BT shunt from January 2008 to November 2015 were reviewed from the 4 member centers of the Congenital Catheterization Research Collaborative. Outcomes were compared by use of propensity score adjustment to account for baseline differences between groups. Results: One hundred six patients with a PDA stent and 251 patients with a BT shunt were included. The groups differed in underlying anatomy (expected 2-ventricle circulation in 60% of PDA stents versus 45% of BT shunts; P=0.001) and presence of antegrade pulmonary blood flow (61% of PDA stents versus 38% of BT shunts; P<0.001). After propensity score adjustment, there was no difference in the hazard of the primary composite outcome of death or unplanned reintervention to treat cyanosis (hazard ratio, 0.8; 95% confidence interval [CI], 0.52-1.23; P=0.31). Other reinterventions were more common in the PDA stent group (hazard ratio, 29.8; 95% CI, 9.8-91.1; P<0.001). However, the PDA stent group had a lower adjusted intensive care unit length of stay (5.3 days [95% CI, 4.2-6.7] versus 9.19 days [95% CI, 7.9-10.6]; P<0.001), a lower risk of diuretic use at discharge (odds ratio, 0.4; 95% CI, 0.25-0.64; P<0.001) and procedural complications (odds ratio, 0.4; 95% CI, 0.2-0.77; P=0.006), and larger (152 mm 2 /m 2 [95% CI, 132-176] versus 125 mm 2 /m 2 [95% CI, 113-138]; P=0.029) and more symmetrical (symmetry index, 0.84 [95% CI, 0.8-0.89] versus 0.77 [95% CI, 0.75-0.8]; P=0.008] pulmonary arteries at the time of subsequent surgical repair or last follow-up. Conclusions: In this multicenter comparison of palliative PDA stent and BT shunt for infants with ductal-dependent pulmonary blood flow adjusted for differences in patient factors, there was no difference in the primary end point, death or unplanned reintervention to treat cyanosis. However, other markers of morbidity and pulmonary artery size favored the PDA stent group, supporting PDA stent as a reasonable alternative to BT shunt in select patients.

AB - Background: Infants with ductal-dependent pulmonary blood flow may undergo palliation with either a patent ductus arteriosus (PDA) stent or a modified Blalock-Taussig (BT) shunt. A balanced multicenter comparison of these 2 approaches is lacking. Methods: Infants with ductal-dependent pulmonary blood flow palliated with either a PDA stent or a BT shunt from January 2008 to November 2015 were reviewed from the 4 member centers of the Congenital Catheterization Research Collaborative. Outcomes were compared by use of propensity score adjustment to account for baseline differences between groups. Results: One hundred six patients with a PDA stent and 251 patients with a BT shunt were included. The groups differed in underlying anatomy (expected 2-ventricle circulation in 60% of PDA stents versus 45% of BT shunts; P=0.001) and presence of antegrade pulmonary blood flow (61% of PDA stents versus 38% of BT shunts; P<0.001). After propensity score adjustment, there was no difference in the hazard of the primary composite outcome of death or unplanned reintervention to treat cyanosis (hazard ratio, 0.8; 95% confidence interval [CI], 0.52-1.23; P=0.31). Other reinterventions were more common in the PDA stent group (hazard ratio, 29.8; 95% CI, 9.8-91.1; P<0.001). However, the PDA stent group had a lower adjusted intensive care unit length of stay (5.3 days [95% CI, 4.2-6.7] versus 9.19 days [95% CI, 7.9-10.6]; P<0.001), a lower risk of diuretic use at discharge (odds ratio, 0.4; 95% CI, 0.25-0.64; P<0.001) and procedural complications (odds ratio, 0.4; 95% CI, 0.2-0.77; P=0.006), and larger (152 mm 2 /m 2 [95% CI, 132-176] versus 125 mm 2 /m 2 [95% CI, 113-138]; P=0.029) and more symmetrical (symmetry index, 0.84 [95% CI, 0.8-0.89] versus 0.77 [95% CI, 0.75-0.8]; P=0.008] pulmonary arteries at the time of subsequent surgical repair or last follow-up. Conclusions: In this multicenter comparison of palliative PDA stent and BT shunt for infants with ductal-dependent pulmonary blood flow adjusted for differences in patient factors, there was no difference in the primary end point, death or unplanned reintervention to treat cyanosis. However, other markers of morbidity and pulmonary artery size favored the PDA stent group, supporting PDA stent as a reasonable alternative to BT shunt in select patients.

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