Improving Clinical Outcomes By Implementing A Multi-disciplinary Pulmonary Vein Stenosis Team
Rachel D. Vanderlaan, MD PhD1, Andreea Dragulescu, MD1, Andrea Wan, MD1, Crystal Tran1, Shi Joon Yoo, MD1, Michael Seed, MD1, Lars Grosse-Wortmann, MD1, Hartmut Grasemann, MD1, Osami Honjo, MD PhD1, David Barron, MD1, Jennifer L. Russell, MD1, Christopher A. Caldarone, MD2.
1Hospital for Sick Children, Toronto, ON, Canada, 2Texas Childrens Hospital, Houston, TX, USA.
Objective(s):Pulmonary vein stenosis(PVS) is associated with high mortality. In 2015, we instituted a multidisciplinary PVS team and surveillance protocol with the goal of improving outcomes.
Methods: In this retrospective study, we compared patient characteristics, disease surveillance and treatment practices for primary PVS patients prior to the PVS team (NoPVT, first intervention between 2009-2014) and after the introduction of the PVS team (PVT, first intervention between 2015-2019).
Results: The study cohort contained 29 patients in the NoPVT group and 33 patients in the PVT group. We found no significant difference between the median age of first intervention (0.48 (0.22-0.92) years, NoPVT vs 0.66 (0.5-1.1) years, PVT), presence of bilateral disease (34%,NoPVT vs 65%, PVT) and number of stenotic veins at diagnosis (2.1 ± 0.15 veins, NoPVT vs 2.3± 0.18 veins PVT). Following PVS interventions, more patients had surveillance axial imaging after introduction of the PVS team (28% NoPVT vs 72%,PVT; p=0.0003), with an increased average number of surveillance scans per patient (1.2± 0.46 NoPVT vs 2.4±0.33 PVT ). There was an increased number of catheter-based procedures (p=0.05). Freedom from death at 1 and 2 years for primary PVS patients was 56% and 52% in the NoPVT cohort compared to 83% and 70% in the PVT cohort (p=0.068).Conclusions: Adoption of a dedicated PVS team and surveillance protocol has the potential to improve outcomes in children with primary PVS.
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