Outcomes After Bilateral Pulmonary Artery Banding With Ductal Stenting Versus Prostaglandin Infusion For Infants Born With Critical Left Heart Obstruction-Aortic Atresia
Madison B Argo, MD1, David J Barron, MD2, Jessica Bhavsar, BS3, James K Kirklin, MD4, Pirooz Eghtesady, MD, PhD5, Mark E Galantowicz, MD6, Kristine J Guleserian, MD7, Osami Honjo, MD, PhD2, S. Adil Husain, MD8, Jeffrey P Jacobs, MD9, Marshall L Jacobs, MD10, Anusha Jegatheeswaran, MD, PhD11, John M Karamichalis, MD12, Tara Karamlou, MD, MSc13, Linda M Lambert, MSN-cFNP8, Ashok Muralidaran, MD14, Tharini Paramananthan, MScN, RN2, Christian Pizarro, MD15, Maha Rahman, BSc2, Karthik Ramakrishnan, MD16, Jennifer C Romano, MD, MS17, Elizabeth H Stephens, MD, PhD18, Karl F Welke, MD19, Can Yerebakan, MD20, Brian W McCrindle, MD, MPH2.
1University of Wisconsin, Madison, WI, USA, 2The Hospital for Sick Children, Toronto, ON, Canada, 3Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA, 4University of Alabama - Birmingham, Birmingham, AL, USA, 5St. Louis Children's Hospital, St. Louis, MO, USA, 6Nationwide Children's Hospital, Columbus, OH, USA, 7Medical City Children's Congenital Heart Surgery, Dallas, TX, USA, 8Primary Children's Hospital, Salt Lake City, UT, USA, 9University of Florida, Gainesville, FL, USA, 10Johns Hopkins University School of Medicine, Baltimore, MD, USA, 11Great Ormond Street Hospital, London, United Kingdom, 12Columbia University, New York, NY, USA, 13Cleveland Clinic, Cleveland, OH, USA, 14Doernbecher Children's Hospital, Portland, OR, USA, 15Nemours Children's Health - Delaware, Wilmington, DE, USA, 16Le Bonheur Children's Hospital, Memphis, TN, USA, 17Mott's Children's Hospital, Ann Arbor, MI, USA, 18Mayo Clinic, Rochester, MN, USA, 19Atrium Health Levine Children's Congenital Heart Center, Charlotte, NC, USA, 20Children's National Hospital, Washington, DC, USA.
Objective(s): To determine patient characteristics and outcomes after bilateral pulmonary artery banding (bPAB) with ductal stenting versus ongoing PGE1 infusion for infants with critical left heart obstruction-aortic atresia (CLHO-AA).
Methods: From 2005-2019, 112 infants with CLHO-AA underwent bPAB with ductal stenting (n=70) or PGE1 (n=42) across 19 Congenital Heart Surgeons' Society institutions. Competing risk methodology was used to compare the time-related risk of short-term outcomes (post-bPAB death or survival to next operation [Norwood, comprehensive stage II, or transplantation]) and intermediate-term outcomes (death, transplantation, or Fontan).
Results: Patient characteristics and anatomy were similar between groups. Reverse BTT shunts were inserted for 14 infants (13 had ductal stenting). For the ductal stenting group, 19 (27%) died post-bPAB and 51 underwent a next operation after a median of 151 days. For the PGE1 group, 4 (10%) died post-bPAB and 38 underwent a next operation after a median of 23 days (Figure). Subsequently, at 5 years after bPAB, 29% with ductal stenting versus 39% with PGE1 underwent Fontan (p=0.35), 14% versus 20% underwent transplantation (p=0.19), 46% versus 32% died (p=0.21), and 11% versus 9% were alive without transition, respectively.
Conclusions: Infants with CLHO-AA managed with bPAB+PGE1 transition earlier to the next operation, spending less time in a high-risk physiologic state versus bPAB+ductal stenting, yet there were no statistically significant differences in intermediate-term outcomes between these 2 groups.
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