Comparison of Ductal Stent Versus Surgical Shunt as Initial Intervention for Neonates with Pulmonary Atresia with Intact Ventricular Septum

• Published in: Pediatric cardiology 2024-06
• Main Authors: Puente, Bao Nguyen, Mastropietro, Christopher W, Flores, Saul, Cheung, Eva W, Amula, Venugopal, Radman, Monique, Kwiatkowski, David, Buckley, Jason R, Allen, Kiona, Loomba, Rohit, Karki, Karan, Chiwane, Saurabh, Cashen, Katherine, Piggott, Kurt, Kapileshwarkar, Yamini, Gowda, Keshava Murthy Narayana, Badheka, Aditya, Raman, Rahul, Costello, John M, Zang, Huaiyu, Iliopoulos, Ilias
• Format: Article
• Language: English
• ISSN: 1432-1971
• DOI: 10.1007/s00246-024-03529-2

Data comparing surgical systemic-to-pulmonary artery shunt and patent ductus arteriosus (PDA) stent as the initial palliation procedure for patients with pulmonary atresia with intact ventricular septum (PA-IVS) are limited. We sought to compare characteristics and outcomes in a multicenter cohort of patients with PA-IVS undergoing surgical shunts versus PDA stents. We retrospectively reviewed neonates with PA-IVS from 2009 to 2019 in 19 United States centers. Bivariate comparisons and multivariable logistic regression analysis were performed to determine the relationship between initial palliation strategy and outcomes including major adverse cardiovascular events (MACE): stroke, mechanical circulatory support, cardiac arrest, or death. 187 patients were included: 38 PDA stents and 149 surgical shunts. Baseline characteristics did not differ statistically between groups. Post-procedural MACE occurred in 4 patients (11%) with PDA stents versus 38 (26%) with surgical shunts, p = 0.079. Overall, the initial palliation strategy was not significantly associated with MACE (aOR:0.37; 95% CI,0.13-1.02). In patients with moderate-to-severe right ventricle hypoplasia, PDA stents were significantly associated with decreased odds of MACE (aOR:0.36; 95% CI,0.13-0.99). PDA stents were associated with lower vasoactive inotrope scores (median 0 versus 5, p