211. Bilateral Pulmonary Artery Banding Palliation (Hybrid Procedure) Versus Other Management Strategies for a Multi-Institutional Cohort of Infants with Critical Left Heart Obstruction
Boston Children's Hospital
Boston, MA
United States - Contact Me
Dr. Pedro J. del Nido, is Chief of the Department of Cardiovascular Surgery at Boston Children’s Hospital, and the William E. Ladd Professor of Child Surgery at Harvard Medical School. His clinical focus is on surgical techniques for achieving bi-ventricular circulation in children with complex heart disease, and repair of congenital heart valve defects. He is Past-President of the American Association for Thoracic Surgery, a leading international organization of academic Cardiothoracic Surgeons. He has received continuous NIH funding for his laboratory research work for over 20 years. His current research work aims to design and develop novel medical devices and procedures that address the specific needs of pediatric patients. He has over 500 peer reviewed publications, and 29 issued and pending patents, including for “del Nido Cardioplegia”.
Congenital Heart Surgeons' Society Center for Research and Quality
United States - Contact Me
Madison B. Argo is the current Kirklin/Ashburn Fellow at the Congenital Heart Surgeons' Society Center for Research and Quality. She is a general surgery resident at the University of Wisconsin and is interested in specializing in congenital heart surgery.
Abstract
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