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Ductal Stenting Is Associated With Improved Survival Compared To Surgical Systemic-to-Pulmonary Shunts In Patients With Single Ventricle Heart Disease
Neel K. Prabhu, BSE, Alexander Zhu, MD, James M. Meza, MD, MSc, Kevin D. Hill, MD, Gregory A. Fleming, MD, Reid C. Chamberlain, MD, Andrew J. Lodge, MD, Joseph W. Turek, MD, PhD, MBA, Nicholas D. Andersen, MD.
Duke University Medical Center, Durham, NC, USA.

Objective(s): Systemic-to-pulmonary shunts (SPS) are associated with poor outcomes in neonates with single ventricle heart defects and ductal dependent pulmonary blood flow (ddPBF). We hypothesized that ductal stenting, an alternate treatment strategy, would be associated with decreased morbidity and mortality compared to SPS in this understudied patient population.
Methods: From 2015 to 2019, 34 single ventricle neonates at our institution underwent DS (n=11) or SPS placement (n=23) based on favorability of ductal anatomy. Procedural success was defined as retention of the planned shunt/stent without revision until stage II palliation or death. Kaplan-Meier survival analysis was performed.
Results: The distribution of patient diagnoses, age, weight, and pre-operative oxygen saturation did not differ between groups. Procedural success did not differ (82% vs 83%, p=0.99). Two DS patients were converted to SPS due to ductal vasospasm and left pulmonary artery obstruction. Four SPS patients required shunt revision. DS patients had shorter post-operative mechanical ventilation duration (1 vs 3 days, p=0.009) and quantitatively decreased post-operative extracorporeal membrane oxygenation requirement (18% vs 44%, p=0.14). A higher proportion of DS patients survived to stage II palliation (100% vs 62%, p=0.01). Survival at one year was greater in DS patients (Figure, 100% vs. 6110.3%, p=0.02).
Conclusions: In neonates with single ventricle heart defects and ddPBF, DS was associated with reduced morbidity and greater survival to stage II palliation compared to surgical SPS.


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