Bilateral Pulmonary Artery Banding Palliation (Hybrid Procedure) Versus Other Management Strategies for a Multi-Institutional Cohort of Infants with Critical Left Heart Obstruction
Presented During:
Monday, May 8, 2023: 10:40AM - 11:00AM
Los Angeles Convention Center
Posted Room Name:
West Hall B
Abstract No:
211
Submission Type:
Abstract Submission
Authors:
Madison Argo (1), David Barron (1), Eugene Blackstone (2), Igor Bondarenko (3), William DeCampli (4), Aaron Eckhauser (5), Peter Gruber (6), Linda Lambert (7), Tharini Paramananthan (8), Maha Rahman (8), David Winlaw (9), Can Yerebakan (10), Bahaaldin Alsoufi (11), Osami Honjo (1), James Kirklin (12), James O'Brien (13), Christian Pizarro (14), Carol Prospero (15), Karthik Ramakrishnan (16), james St. Louis (17), Joseph Turek (18), Petros Anagnostopoulos, MD (19), Marcus Haw (20), Marshall Jacob
Institutions:
(1) Hospital for Sick Children, Toronto, ON, (2) Cleveland Clinic, Cleveland, OH, (3) Children's Hospital of Michigan, Detroit, MI, (4) Arnold Palmer Hospital for Children, Winter Park, FL, (5) Primary Children's Hospital, Salt Lake City, UT, (6) Yale New Haven Hospital, New Haven, CT, (7) Primary Children's Hospital, Salt Lake, UT, (8) Hospital for Sick Children, Toronto, Ontario, (9) Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (10) Children's National Hospital, Washington, DC, (11) Norton Children's Hospital, Louisville, KY, (12) University of Alabama at Birmingham, Birmingham, AL, (13) Children's Mercy Hospital, Kansas City, MO, (14) Alfred I duPont Hospital for Children, Wilmington, DE, (15) Alfred I. duPont Hospital for Children, Wilmington, DE, (16) LeBonheur Children's Hospital, Memphis, TN, (17) Children's Hospital of Georgia, Evans, GA, (18) Duke Children's Hospital, Durham, NC, (19) American Family Children's Hospital, Madison, WI, (20) Helen DeVos Childrens Hospital, Grand Rapids, MI, (21) N/A, Newtown Square, PA, (22) Mayo Clinic, Rochester, MN, (23) Children's Hospital of Georgia, Augusta, GA
Submitting Author:
Madison Argo
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Hospital for Sick Children
Hospital for Sick Children
Co-Author(s):
*David Barron
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Hospital for Sick Children
Hospital for Sick Children
*Eugene Blackstone
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Cleveland Clinic
Cleveland Clinic
Igor Bondarenko
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Children's Hospital of Michigan
Children's Hospital of Michigan
William DeCampli
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Arnold Palmer Hospital for Children
Arnold Palmer Hospital for Children
*Aaron Eckhauser
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Primary Children's Hospital
Primary Children's Hospital
*Peter Gruber
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Yale New Haven Hospital
Yale New Haven Hospital
Linda Lambert
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Primary Children's Hospital
Primary Children's Hospital
Tharini Paramananthan
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Hospital for Sick Children
Hospital for Sick Children
Maha Rahman
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Hospital for Sick Children
Hospital for Sick Children
*David Winlaw
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Cincinnati Children's Hospital Medical Center
Cincinnati Children's Hospital Medical Center
*Can Yerebakan
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Children's National Hospital
Children's National Hospital
*Bahaaldin Alsoufi
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Norton Children's Hospital
Norton Children's Hospital
*Osami Honjo
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Hospital for Sick Children
Hospital for Sick Children
James Kirklin
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University of Alabama at Birmingham
University of Alabama at Birmingham
James O'Brien
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Children's Mercy Hospital
Children's Mercy Hospital
*Christian Pizarro
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Alfred I duPont Hospital for Children
Alfred I duPont Hospital for Children
Carol Prospero
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Alfred I. duPont Hospital for Children
Alfred I. duPont Hospital for Children
Karthik Ramakrishnan
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LeBonheur Children's Hospital
LeBonheur Children's Hospital
James St. Louis
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Children's Hospital of Georgia
Children's Hospital of Georgia
*Joseph Turek
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Duke Children's Hospital
Duke Children's Hospital
Petros Anagnostopoulos
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American Family Children's Hospital
American Family Children's Hospital
Marcus Haw
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Helen DeVos Childrens Hospital
Helen DeVos Childrens Hospital
Marshall Jacobs
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Anusha Jegatheeswaran, MD, PhD, FRCSC
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Hospital for Sick Children
Hospital for Sick Children
*Tara Karamlou
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Cleveland Clinic
Cleveland Clinic
Elizabeth Stephens
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Mayo Clinic
Mayo Clinic
Anastasios Polimenakos
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Children's Hospital of Georgia
Children's Hospital of Georgia
Brian McCrindle
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Hospital for Sick Children
Hospital for Sick Children
Presenting Author:
Madison Argo
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Abstract:
Objective: We sought to determine the difference in patient characteristics and overall survival for infants with critical left heart obstruction (CLHO) who received bilateral pulmonary artery banding (bPAB) ± ductal stent palliation versus those who received other management strategies (e.g. Norwood, primary transplant, biventricular repair, or surgical/transcatheter aortic valvotomy).
Methods: From 2005-2019, 214 of 962 (22%) infants enrolled in the Congenital Heart Surgeons' Society CLHO cohort underwent bPAB ± ductal stent palliation at 24 institutions. Median follow-up was 8.6 years (range: 0.01-17.4 years). Using a weighting method based on propensity analysis, infants who had bPAB were matched to infants who received other management strategies on variables significantly associated with mortality and variables noted to be significantly different between the two groups. Applying the propensity weighting method, parametric hazard modeling for overall survival was performed (data from all 962 infants were incorporated and weighted) and bootstrap resampling was used to compare risk-adjusted survival between groups.
Results: Compared to infants who received other management strategies, infants who underwent bPAB had higher prevalence of prenatal interventions, non-cardiac comorbidities (e.g. genetic syndromes), preoperative intubation, absent interatrial communication, moderate or severe mitral valve stenosis, lower birth weight, and younger gestational age (all p-values <0.03). For survivors after bPAB, 10% (21/214) had primary transplant, 9% (19/214) had biventricular repair, and 65% (138/214) had univentricular palliation. For the 748 infants who received other management strategies, 1% (10/748) had primary transplant, 14% (104/748) had biventricular repair, and 84% (625/748) had Norwood operation. After applying propensity weighting to both groups, the 12-year risk-adjusted survival after bPAB versus other management strategies was 58% and 63%, respectively (early hazard phase p=0.36, late hazard phase p=0.96; Figure 1).
Conclusions: Infants born with CLHO who underwent bPAB have more high-risk patient-related and anatomic characteristics versus infants who received other management strategies. However, after risk-adjustment, overall survival was similar between the two groups. Mortality remains high for infants born with CLHO, especially for those who have high-risk characteristics, and a bPAB palliation strategy has not diminished this risk
Methods: From 2005-2019, 214 of 962 (22%) infants enrolled in the Congenital Heart Surgeons' Society CLHO cohort underwent bPAB ± ductal stent palliation at 24 institutions. Median follow-up was 8.6 years (range: 0.01-17.4 years). Using a weighting method based on propensity analysis, infants who had bPAB were matched to infants who received other management strategies on variables significantly associated with mortality and variables noted to be significantly different between the two groups. Applying the propensity weighting method, parametric hazard modeling for overall survival was performed (data from all 962 infants were incorporated and weighted) and bootstrap resampling was used to compare risk-adjusted survival between groups.
Results: Compared to infants who received other management strategies, infants who underwent bPAB had higher prevalence of prenatal interventions, non-cardiac comorbidities (e.g. genetic syndromes), preoperative intubation, absent interatrial communication, moderate or severe mitral valve stenosis, lower birth weight, and younger gestational age (all p-values <0.03). For survivors after bPAB, 10% (21/214) had primary transplant, 9% (19/214) had biventricular repair, and 65% (138/214) had univentricular palliation. For the 748 infants who received other management strategies, 1% (10/748) had primary transplant, 14% (104/748) had biventricular repair, and 84% (625/748) had Norwood operation. After applying propensity weighting to both groups, the 12-year risk-adjusted survival after bPAB versus other management strategies was 58% and 63%, respectively (early hazard phase p=0.36, late hazard phase p=0.96; Figure 1).
Conclusions: Infants born with CLHO who underwent bPAB have more high-risk patient-related and anatomic characteristics versus infants who received other management strategies. However, after risk-adjustment, overall survival was similar between the two groups. Mortality remains high for infants born with CLHO, especially for those who have high-risk characteristics, and a bPAB palliation strategy has not diminished this risk
CONGENTIAL:
Neonatal and Pediatric Cardiac Surgery
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