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Sirisani JD, Haranal M, Soo KW, Sivalingam S, Mohd Khalid KF. Comparison of Immediate Intensive Care Outcomes of Patent Ductus Arteriosus Stenting Versus Modified Blalock-Taussig-Thomas Shunt in Infants With Ductal-Dependent Pulmonary Circulation. Pediatr Cardiol 2024:10.1007/s00246-024-03591-w. [PMID: 39073479 DOI: 10.1007/s00246-024-03591-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
Patent Ductus Arteriosus (PDA) stenting is an alternative to Modified Blalock-Taussig-Thomas Shunt (BT) to increase pulmonary blood flow in ductal-dependent pulmonary circulation. The objective of this study is to compare the immediate Intensive Care Unit (ICU) outcomes of PDA stent versus BT shunt in infants with ductal-dependent pulmonary circulation. This is a single center, retrospective study in infants less than 6 months with ductal-dependent pulmonary circulation palliated with either PDA stenting or BT shunt from January 2015 till December 2023. Data were reviewed from pediatric ICU database. Demographics details, ICU parameters, mortality and morbidity were compared. The propensity score with inverse probability weighting was used to control the effect of covariates. A total of 302 patients with PDA stenting and 100 patients with BT shunt were included. Majority of the patients had intervention at first month of life. 126 (41.7%) patient underwent PDA stenting while 36 (36%) had BTS. The PDA stenting group has shorter ICU stay, 3 (2.0,6.0) days versus 8 (4.8,13.0) days (p < 0.001), shorter length of hospital stay, 9 (6.8,15.0) days versus 16 (11.0,22.0) days (p < 0.001), shorter ventilation days, 2 (1.0,4.0) days versus 3 (2.0,7.0) days (p < 0.001) and lower mortality, 7 (2.3%) versus 16 (16.0%) (p < 0.001). At 3 months follow-up, the survival was higher in the PDA stenting group (p < 0.001). Conclusion: PDA stenting in infants with ductal-dependent pulmonary blood flow has a more favorable intensive care outcomes with shorter ICU and hospital stay. PDA stenting has a better survival outcome.
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Affiliation(s)
- Joyce Darshinee Sirisani
- Pediatric and Congenital Heart Centre, National Heart Institute, 145 Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia.
| | - Maruti Haranal
- Department of Cardiothoracic and Vascular Surgery, National Heart Institute, 145 Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | - Kok Wai Soo
- Pediatric and Congenital Heart Centre, National Heart Institute, 145 Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | - Sivakumar Sivalingam
- Department of Cardiothoracic and Vascular Surgery, National Heart Institute, 145 Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | - Khairul Faizah Mohd Khalid
- Pediatric and Congenital Heart Centre, National Heart Institute, 145 Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
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El-Said H, Hussein A, Price K, Heibel J, Haley J, Haldeman S, Boulil Z, Brigger M, Rao A, Ganta S, Rao R, Nigro J, Sweeney N. Comparing Neurodevelopmental Outcomes in Infants With Patent Ductus Arteriosus Stenting Versus Blalock-Taussig-Thomas Shunt: A Pilot Study. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101355. [PMID: 39132454 PMCID: PMC11307534 DOI: 10.1016/j.jscai.2024.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 01/10/2024] [Accepted: 02/08/2024] [Indexed: 08/13/2024]
Abstract
Background Patent ductus arteriosus stenting (PDAS) is a nonsurgical alternative to Blalock-Taussig-Thomas shunt (BTTS) for infants with ductal-dependent congenital heart disease. In this single-center study, we aimed to compare neurodevelopmental outcomes in children who underwent BTTS as initial palliation versus PDAS. Methods Bayley Scales of Infant and Toddler Development Screening Test (Bayley-III) reports and mode of feeding data were collected for any patient who underwent PDAS or BTTS at Rady Children's Hospital from 2013 to 2021. We also prospectively administered the Parents' Evaluation of Development Status questionnaire (PEDS) to parents of children aged 2-8 years in this patient population. Results Of the 99 patients, 64 received a Bayley-III assessment and/or PEDS screen. Of the 35 who had a Bayley-III, there was a higher proportion of patients with PDAS who scored as developmentally appropriate compared with BTTS. PEDS screen showed that a higher proportion of patients with PDAS had no parental concern for delay than that of patients with BTTS (63% vs 30%). Patients with BTTS were more likely to undergo gastrostomy tube placement than patients with PDAS. Conclusions Our study suggests that neurodevelopmental measures are feasible, clinically relevant, and should be included in comparative effectiveness studies of infant congenital interventions. Whether PDAS offers neurodevelopmental benefit over BTTS should be confirmed in a prospective powered randomized controlled clinical trial.
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Affiliation(s)
- Howaida El-Said
- Department of Pediatrics, University of California San Diego, La Jolla, California
- Division of Cardiology, Rady Children’s Hospital-San Diego, San Diego, California
| | - Amira Hussein
- Division of Cardiology, Rady Children’s Hospital-San Diego, San Diego, California
| | - Katherine Price
- University of California San Diego School of Medicine, La Jolla, California
| | - Jessica Heibel
- Division of Cardiology, Rady Children’s Hospital-San Diego, San Diego, California
| | - Jessica Haley
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Shylah Haldeman
- Division of Cardiology, Rady Children’s Hospital-San Diego, San Diego, California
| | - Zeinab Boulil
- Division of Cardiology, Rady Children’s Hospital-San Diego, San Diego, California
| | - Matthew Brigger
- Department of Otolaryngology, University of California San Diego, La Jolla, California
- Division of Pediatric Otolaryngology, Rady Children’s Hospital-San Diego, San Diego, California
| | - Aparna Rao
- Department of Pediatrics, University of California San Diego, La Jolla, California
- Division of Pediatric Pulmonology, Rady Children’s Hospital-San Diego, San Diego, California
| | - Srujan Ganta
- Division of Cardiology, Rady Children’s Hospital-San Diego, San Diego, California
| | - Rohit Rao
- Department of Pediatrics, University of California San Diego, La Jolla, California
- Division of Cardiology, Rady Children’s Hospital-San Diego, San Diego, California
| | - John Nigro
- Division of Cardiology, Rady Children’s Hospital-San Diego, San Diego, California
- Department of Surgery, University of California San Diego, La Jolla, California
- Division of Cardiothoracic Surgery, Rady Children’s Hospital-San Diego, San Diego, California
| | - Nathaly Sweeney
- Department of Pediatrics, University of California San Diego, La Jolla, California
- Division of Neonatology, Rady Children’s Hospital-San Diego, San Diego, California
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Ganta S, Haley J, El-Said H, Lane B, Haldeman S, Karamlou T, Moore J, Rao R, Nigro JJ. Stage 1 and 2 Palliation: Comparing Ductal Stenting and Aorto-Pulmonary Shunts in Single Ventricles with Duct-Dependent Pulmonary Blood Flow. Pediatr Cardiol 2024; 45:471-482. [PMID: 38265483 PMCID: PMC10891206 DOI: 10.1007/s00246-023-03386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
Patent ductus arteriosus stenting (PDAS) for ductal-dependent pulmonary blood flow (DDPBF) provides a new paradigm for managing neonates with single ventricles (SV). Currently, sparse data exist regarding outcomes for subsequent palliation. We describe our experience with inter-stage care and stage 2 (S2P) conversion with PDAS in comparison to a prior era of patients who received surgical aorto-pulmonary shunts (APS). Retrospective review of 18 consecutive DDPBF SV patients treated with PDAS between 2016 and 2021 was done and compared with 9 who underwent APS from 2010 to 2016. Patient outcomes and pulmonary artery (PA) growth were analyzed. S2P was completed in all 18 with PDAS with no cardiac arrests and one post-S2P mortality. In the 9 APS patients, there was one cardiac arrest requiring ECMO and one mortality inter-stage. Off cardiopulmonary bypass strategy was utilized in 10/18 in the PDAS and 1/9 in the APS group (p = 0.005) at S2P. Shorter ventilation time, earlier PO feeding, and shorter hospital stay were noted in the PDAS group (p = 0.01, p = 0.006, p = 0.03) (S2P). Median Nakata index increase inter-stage was not significant between the PDAS and APS at 94.1 mm2/m2 versus 71.7 mm2/m2 (p = 0.94). Median change in pulmonary artery symmetry (PAS) was - 0.02 and - 0.24, respectively, which was statistically significant (p = 0.008). Neurodevelopmental outcomes were better in the PDAS group compared to the APS group (p = 0.02). PDAS provides excellent PA growth, inter-stage survival, progression along multistage single-ventricle palliation, and potentially improved neurodevelopmental outcomes. Most patients can be transitioned through 2 stages of palliation without CPB.
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Affiliation(s)
- Srujan Ganta
- Cardiothoracic Surgery, Rady Children's Hospital + University of California San Diego, 3020 Children's Way, MC5004, San Diego, CA, 92123, USA.
| | - Jessica Haley
- Pediatrics, Division of Cardiology, University of California San Diego, San Diego, CA, USA
| | - Howaida El-Said
- Pediatrics, Division of Cardiology, University of California San Diego, San Diego, CA, USA
| | - Brian Lane
- Pediatrics, Division of Cardiology, University of California San Diego, San Diego, CA, USA
| | - Shylah Haldeman
- Cardiothoracic Surgery, Rady Children's Hospital + University of California San Diego, 3020 Children's Way, MC5004, San Diego, CA, 92123, USA
| | - Tara Karamlou
- Division of Pediatric Cardiac Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John Moore
- Pediatrics, Division of Cardiology, University of California San Diego, San Diego, CA, USA
| | - Rohit Rao
- Pediatrics, Division of Cardiology, University of California San Diego, San Diego, CA, USA
| | - John J Nigro
- Cardiothoracic Surgery, Rady Children's Hospital + University of California San Diego, 3020 Children's Way, MC5004, San Diego, CA, 92123, USA
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Al Kindi H, Al Harthi H, Al Balushi A, Atiq A, Shaikh S, Al Alawi K, Al-Farqani A. Blalock-Taussig Shunt versus Ductal Stenting as Palliation for Duct-Dependent Pulmonary Circulation. Sultan Qaboos Univ Med J 2023; 23:10-15. [PMID: 38161753 PMCID: PMC10754312 DOI: 10.18295/squmj.12.2023.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/14/2023] [Accepted: 04/19/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives There is limited data published from outside North America and Europe comparing the outcomes of a modified Blalock-Taussig shunt (MBTS) and ductal stenting as the first palliative procedure for infants with duct-dependent pulmonary circulation. This study reports the National Heart Center's, in Muscat, Oman, experience in comparing the outcomes of these 2 interventions. Methods This retrospective study included all infants with duct-dependent pulmonary circulation who received either a MBTS or ductal stenting from 2016-2019. The primary outcomes were death or re-interventions. Secondary outcomes included death, subsequent re-interventions, survival to subsequent surgical intervention, survival to hospital discharge, post-procedural mechanical ventilation and duration of intensive care unit stay. Results A total of 71 patients were included in the study, 33 (46%) of whom received ductal stenting. The prevalence of the primary outcome (death or re-intervention) in the patent ductus arteriosus (PDA) stent group was 54.5% versus 31.6% in the MBTS group but this was not statistically significant (P = 0.06). There was no difference between the 2 groups in terms of time to next surgical intervention (P = 0.233). The PDA stent group had shorter post-procedural, mechanical ventilation and intensive care unit stay durations (P <0.05). Syndromic patients were at higher risk of mortality compared to non-syndromic patients. Conclusion MBTS and ductal stenting are both acceptable modalities as a palliative intervention for infants with duct-dependant pulmonary circulation. Syndromic patients are at higher risk of mortality. This can be considered an important factor for patient selection.
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Affiliation(s)
- Hamood Al Kindi
- Department of Surgery, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
- Department of Cardiothoracic Surgery, National Heart Center, Royal Hospital, Muscat, Oman
| | | | - Asim Al Balushi
- Department of Pediatric Cardiology, National Heart Center, Muscat, Oman
| | - Ahlam Atiq
- Department of Pediatric Cardiology, National Heart Center, Muscat, Oman
| | | | - Khalid Al Alawi
- Department of Pediatric Cardiology, National Heart Center, Muscat, Oman
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Nicholson GT, Goldstein BH, Petit CJ, Qureshi AM, Glatz AC, McCracken CE, Kelleman MS, Meadows JJ, Zampi JD, Shahanavaz S, Mascio CE, Chai PJ, Romano JC, Healan SJ, Pettus JA, Batlivala SP, Raulston JEB, Hock KM, Maskatia SA, Beshish A, Law MA. Impact of Management Strategy on Feeding and Somatic Growth in Neonates with Symptomatic Tetralogy of Fallot: Results from the Congenital Cardiac Research Collaborative. J Pediatr 2022; 250:22-28.e4. [PMID: 35772511 DOI: 10.1016/j.jpeds.2022.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate early growth following primary or staged repair of neonatal symptomatic tetralogy of Fallot (sTOF). STUDY DESIGN We performed a retrospective, multicenter cohort study of consecutive infants with sTOF who underwent initial intervention at age ≤30 days, from 2005 to 2017. Management strategies were either primary repair or staged repair (ie, initial palliation followed by complete repair). The primary outcome was change in weight-for-age z-score (ΔWAZ) from the initial intervention to age 6 ± 2 months. Secondary outcomes included method and mode of feeding, feeding-related medications, and feeding-related readmissions. Propensity score adjustment was used to account for baseline differences between groups. A secondary analysis was performed comparing patients stratified by the presence of adequate growth (6-month ΔWAZ > -0.5) or inadequate growth (6-month ΔWAZ ≤ -0.5), independent of treatment strategy. RESULTS The study cohort included 143 primary repair subjects and 240 staged repair subjects. Prematurity was more common in the staged repair group. After adjustment, median ΔWAZ did not differ between treatment groups over the first 6 months of life (primary: -0.43 [IQR, -1.17 to 0.50]; staged: -0.31 [IQR, -1.31 to 0.71]; P = .55). For the entire cohort, ΔWAZ was negative (-0.36; IQR, -1.21 to 0.63). There were no between-group differences in the secondary outcomes. Secondary analysis revealed that the subjects with adequate growth were more likely to be orally fed at initial hospital discharge (P = .04). CONCLUSIONS In neonates with sTOF, growth trajectory over the first 6 months of life was substandard, irrespective of treatment strategy. Those patients with adequate growth were more likely to be discharged from the index procedure on oral feeds.
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Affiliation(s)
- George T Nicholson
- Division of Cardiology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
| | - Bryan H Goldstein
- The Heart Institute, Cincinnati Children's Hospital Medical Center and Division of Pediatric Cardiology, University of Cincinnati College of Medicine, Cincinnati, OH; Heart Institute, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Christopher J Petit
- Children's Heart Center Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; Morgan Stanley Children's Hospital, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
| | - Athar M Qureshi
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Andrew C Glatz
- The Cardiac Center, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Courtney E McCracken
- Children's Heart Center Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Michael S Kelleman
- Children's Heart Center Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Jeffery J Meadows
- Division of Cardiology, Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, CA
| | - Jeffrey D Zampi
- Division of Cardiology, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI
| | - Shabana Shahanavaz
- The Heart Institute, Cincinnati Children's Hospital Medical Center and Division of Pediatric Cardiology, University of Cincinnati College of Medicine, Cincinnati, OH; Section of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO
| | - Christopher E Mascio
- The Cardiac Center, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Pediatric Cardiothoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Paul J Chai
- Children's Heart Center Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Jennifer C Romano
- Section of Pediatric Cardiothoracic Surgery, Department of Cardiac Surgery, CS Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI
| | - Steven J Healan
- Division of Cardiology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Joelle A Pettus
- Children's Heart Center Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Sarosh P Batlivala
- The Heart Institute, Cincinnati Children's Hospital Medical Center and Division of Pediatric Cardiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - James E B Raulston
- Division of Pediatric Cardiology, Department of Pediatrics, Children's of Alabama, University of Alabama Birmingham School of Medicine, Birmingham, AL
| | - Kristal M Hock
- Division of Pediatric Cardiology, Department of Pediatrics, Children's of Alabama, University of Alabama Birmingham School of Medicine, Birmingham, AL
| | - Shiraz A Maskatia
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Asaad Beshish
- Children's Heart Center Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Mark A Law
- Division of Pediatric Cardiology, Department of Pediatrics, Children's of Alabama, University of Alabama Birmingham School of Medicine, Birmingham, AL
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Wespi R, Callegari A, Quandt D, Logoteta J, von Rhein M, Kretschmar O, Knirsch W. Favourable Short- to Mid-Term Outcome after PDA-Stenting in Duct-Dependent Pulmonary Circulation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12794. [PMID: 36232092 PMCID: PMC9566406 DOI: 10.3390/ijerph191912794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Stenting of patent ductus arteriosus (PDA) is a minimally invasive catheter-based temporary palliative procedure that is an alternative to a surgical shunt in neonates with duct-dependent pulmonary perfusion. METHODS An observational, single-centre, cross-sectional study of patients with duct-dependent pulmonary perfusion undergoing PDA-stenting as a stage I procedure and an analysis of short- to mid-term follow-up until a subsequent surgical procedure (stage II), with a focus on the interstage course. RESULTS Twenty-six patients were treated with PDA-stenting at a median (IQR) age of 7 (4-10) days; 10/26 patients (38.5%) (6/10 single pulmonary perfusion) were intended for later univentricular palliation, 16/26 patients (61.5%) (13/16 single pulmonary perfusion) for biventricular repair. PDA diameter was 2.7 (1.8-3.2) mm, stent diameter 3.5 (3.5-4.0) mm. Immediate procedural success was 88.5%. The procedure was aborted, switching to immediate surgery after stent embolisation, malposition or pulmonary coarctation in three patients (each n = 1). During mid-term follow-up, one patient needed an additional surgical shunt due to severe cyanosis, while five patients underwent successful catheter re-intervention 27 (17-30) days after PDA-stenting due to pulmonary hypo- (n = 4) or hyperperfusion (n = 1). Interstage mortality was 8.6% (2/23), both in-hospital and non-procedure-related. LPA grew significantly (p = 0.06) between PDA-stenting and last follow-up prior to subsequent surgical procedure (p = 0.06). RPA Z-scores remained similar (p = 0.22). The subsequent surgical procedure was performed at a median age of 106 (76.5-125) days. CONCLUSIONS PDA-stenting is a feasible, safe treatment option, with the need for interdisciplinary decision-making beforehand and surgical backup afterwards. It allows adequate body and pulmonary vessel growth for subsequent surgical procedures. Factors determining the individual patient's course should be identified in larger prospective studies.
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Affiliation(s)
- Regina Wespi
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
| | - Alessia Callegari
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
| | - Daniel Quandt
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
| | - Jana Logoteta
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
| | - Michael von Rhein
- University of Zurich, 8006 Zurich, Switzerland
- Child Development Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Oliver Kretschmar
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
| | - Walter Knirsch
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
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Transcatheter Device Therapy and the Integration of Advanced Imaging in Congenital Heart Disease. CHILDREN 2022; 9:children9040497. [PMID: 35455541 PMCID: PMC9032030 DOI: 10.3390/children9040497] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 01/04/2023]
Abstract
Transcatheter device intervention is now offered as first line therapy for many congenital heart defects (CHD) which were traditionally treated with cardiac surgery. While off-label use of devices is common and appropriate, a growing number of devices are now specifically designed and approved for use in CHD. Advanced imaging is now an integral part of interventional procedures including pre-procedure planning, intra-procedural guidance, and post-procedure monitoring. There is robust societal and industrial support for research and development of CHD-specific devices, and the regulatory framework at the national and international level is patient friendly. It is against this backdrop that we review transcatheter implantable devices for CHD, the role and integration of advanced imaging, and explore the current regulatory framework for device approval.
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Arar Y, Dimas VV, Nugent AW, Hussain T, Kasraie N, Reddy SRV, Zellers TM, Herbert C. Pre-procedural CT imaging aids neonatal PDA stenting for ductal-dependent pulmonary blood flow with reduction in overall procedural morbidity. Cardiol Young 2021; 32:1-6. [PMID: 34663483 DOI: 10.1017/s1047951121004133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patent ductus arteriosus stenting for ductal-dependent pulmonary blood flow is a technically challenging neonatal procedure to maintain a stable pulmonary circulation. Pre-procedural computed tomography imaging aids in outlining ductal origin, insertion, size, course and curvature. Computed tomography imaging may add value to procedural outcomes and reduce overall procedural morbidity in neonatal patent ductus arteriosus stenting. We conducted a single centre retrospective chart review of neonates with ductal-dependent pulmonary blood flow who underwent patent ductus arteriosus stenting between January 1, 2014 and June 31, 2020. We compared patients variables between patients who underwent pre-procedural computed tomography imaging to those who did not. A total of 64 patients were referred for patent ductus arteriosus stenting with 33 (52%) obtaining pre-procedural computed tomography imaging. Average age [19 days; range 1-242 days (p = 0.85)] and weight [3.3 kg (range 2.2-6.0 kg; p = 0.19)] was not significantly different between the groups. A diagnosis of pulmonary atresia was made in 42 out of 64 (66%) patients prior to patent ductus arteriosus stenting. The cohort with pre-intervention computed tomography imaging had a significant reduction in the total number of access sites (1.2 versus 1.5; p = 0.03), contrast needed (5.9 versus 8.2 ml/kg; p = 0.008), fluoroscopy (20.7 versus 38.8 minutes; p = 0.02) and procedural time (83.4-128.4 minutes; p = 0.002) for the intervention. There was no significant difference in radiation burden between the groups (p = 0.35). Pre-procedural computed tomography imaging adds value by aiding interventional planning for neonatal patent ductus arteriosus stenting. A statistically significant reduction in the number of access sites, contrast exposure, as well as fluoroscopic and procedural time was noted without significantly increasing the cumulative radiation burden.
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Affiliation(s)
- Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - V Vivian Dimas
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - Alan W Nugent
- Department of Pediatrics, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - Nima Kasraie
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Surendranath R Veeram Reddy
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - Thomas M Zellers
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
| | - Carrie Herbert
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Pediatric Cardiology, Children's Medical Center, Dallas, Texas, USA
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Alsaied T, Ashfaq A. From Other Journals: A Review of Recent Articles by Our Editorial Team. Pediatr Cardiol 2021; 42:1235-1240. [PMID: 34181037 DOI: 10.1007/s00246-021-02673-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
In this review, we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our hope is to provide a summary of the latest articles published recently in other journals in our field. The articles reviewed in this manuscript address (1) long-term fate of the truncal valve, (2) comparison of combined heart‒liver vs heart-only transplantation in pediatric and young adult Fontan recipients showing non-inferior survival of heart-liver transplant in a small sample, (3) impact of palliation strategy on interstage feeding and somatic growth for infants with ductal-dependent pulmonary blood flow showing no difference in growth between ductal stenting and Blalock-Taussig shunt, (4) biventricular repair in interrupted aortic arch and ventricular septal defect with a small left ventricular outflow tract, (5) a randomized controlled trial comparing controlled reoxygenation and standard cardiopulmonary bypass in pediatric cardiac surgery, and (6) tricuspid valve and right ventricular function throughout the hybrid palliation strategy for hypoplastic left heart syndrome and variants.
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Affiliation(s)
- Tarek Alsaied
- Heart Institute, Pittsburgh Children's Hospital Medical Center, 4401 Penn Avenue, Pittsburgh, PA, USA. .,Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Awais Ashfaq
- Heart Institute, Johns Hopkins All Children's All Children's Hospital, St. Petersburg, FL, USA
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Qasim A, Qureshi AM. Patent ductus arteriosus stenting for ductal dependent pulmonary blood flow. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Patterns of Growth and Nutrition From Birth to 6 Months in Infants With Complex Congenital Cardiac Defects. Nurs Res 2020; 69:S57-S65. [PMID: 32569101 DOI: 10.1097/nnr.0000000000000460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Infants with complex congenital heart defects (CCHDs) experience alterations in growth that develop following surgical intervention and persist throughout early infancy, but the roles of nutritional intake and method of feeding require further exploration as their roles are not fully explained. OBJECTIVES The purpose of this study was to characterize trends in growth and nutritional intake during the first 6 months of life in infants with CCHD. METHODS We conducted a secondary analysis of growth and nutritional data from a pilot study designed to test the feasibility of nurse-guided participatory intervention with parents of infants with CCHD. Measures included demographic data, anthropometric data at birth, hospital discharge, and 6 months of age, nutritional intake at 2 and 6 months of age from parent-completed 24-hour nutrition diaries, and assessment of oral-motor skills between 1 and 2 months of age. Descriptive statistics and correlation and group differences were examined. RESULTS Data for 28 infants were analyzed. Infants demonstrated a decrease in weight-for-age z score (WAZ) and length-for-age z score (LAZ) from birth to hospital discharge and an increase in WAZ and LAZ by 6 months of age. Many of the infants developed failure to thrive. Across the study period, one third of the infants were receiving enteral nutrition. Infants who were orally fed had better growth WAZ and LAZ at 6 months of age when compared to infants who were enterally fed. DISCUSSION Infants with CCHD exhibit growth faltering throughout early infancy. Reliance on enteral nutrition did not improve growth outcomes in these infants. Findings suggest nutritional intake may not be enough to meet the nutrient requirements to stimulate catch-up growth.
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Nicholson GT, Glatz AC, Qureshi AM, Petit CJ, Meadows JJ, McCracken C, Kelleman M, Bauser-Heaton H, Gartenberg AJ, Ligon RA, Aggarwal V, Kwakye DB, Goldstein BH. Impact of Palliation Strategy on Interstage Feeding and Somatic Growth for Infants With Ductal-Dependent Pulmonary Blood Flow: Results from the Congenital Catheterization Research Collaborative. J Am Heart Assoc 2019; 9:e013807. [PMID: 31852418 PMCID: PMC6988161 DOI: 10.1161/jaha.119.013807] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In infants with ductal‐dependent pulmonary blood flow, the impact of palliation strategy on interstage growth and feeding regimen is unknown. Methods and Results This was a retrospective multicenter study of infants with ductal‐dependent pulmonary blood flow palliated with patent ductus arteriosus (PDA) stent or Blalock‐Taussig shunt (BTS) from 2008 to 2015. Subjects with a defined interstage, the time between initial palliation and subsequent palliation or repair, were included. Primary outcome was change in weight‐for‐age Z‐score. Secondary outcomes included % of patients on: all oral feeds, feeding‐related medications, higher calorie feeds, and feeding‐related readmission. Propensity score was used to account for baseline differences. Subgroup analysis was performed in 1‐ (1V) and 2‐ventricle (2V) groups. The cohort included 66 PDA stent (43.9% 1V) and 195 BTS (54.4% 1V) subjects. Prematurity was more common in the PDA stent group (P=0.051). After adjustment, change in weight‐for‐age Z‐score did not differ between groups over the entire interstage. However, change in weight‐for‐age Z‐score favored PDA stent during the inpatient interstage (P=0.005) and BTS during the outpatient interstage (P=0.032). At initial hospital discharge, PDA stent treatment was associated with all oral feeds (P<0.001) and absence of feeding‐related medications (P=0.002). Subgroup analysis revealed that 2V but not 1V patients demonstrated significant increase in weight‐for‐age Z‐score. In the 2V cohort, feeding‐related readmissions were more common in the BTS group (P=0.008). Conclusions In infants with ductal‐dependent pulmonary blood flow who underwent palliation with PDA stent or BTS, there was no difference in interstage growth. PDA stent was associated with a simpler feeding regimen and fewer feeding‐related readmissions.
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Affiliation(s)
- George T Nicholson
- Division of Cardiology Department of Pediatrics Vanderbilt University School of Medicine Nashville TN
| | - Andrew C Glatz
- Department of Pediatrics The Cardiac Center Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Athar M Qureshi
- Lillie Frank Abercrombie Section of Cardiology Department of Pediatrics Texas Children's Hospital Baylor College of Medicine Houston TX
| | - Christopher J Petit
- Sibley Heart Center Cardiology Department of Pediatrics Children's Healthcare of Atlanta Emory University School of Medicine Atlanta GA
| | - Jeffery J Meadows
- Division of Cardiology Department of Pediatrics University of California San Francisco School of Medicine San Francisco CA
| | - Courtney McCracken
- Sibley Heart Center Cardiology Department of Pediatrics Children's Healthcare of Atlanta Emory University School of Medicine Atlanta GA
| | - Michael Kelleman
- Sibley Heart Center Cardiology Department of Pediatrics Children's Healthcare of Atlanta Emory University School of Medicine Atlanta GA
| | - Holly Bauser-Heaton
- Sibley Heart Center Cardiology Department of Pediatrics Children's Healthcare of Atlanta Emory University School of Medicine Atlanta GA
| | - Ari J Gartenberg
- Department of Pediatrics The Cardiac Center Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - R Allen Ligon
- Sibley Heart Center Cardiology Department of Pediatrics Children's Healthcare of Atlanta Emory University School of Medicine Atlanta GA
| | - Varun Aggarwal
- Lillie Frank Abercrombie Section of Cardiology Department of Pediatrics Texas Children's Hospital Baylor College of Medicine Houston TX
| | - Derek B Kwakye
- The Heart Institute Cincinnati Children's Hospital Medical Center Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH
| | - Bryan H Goldstein
- The Heart Institute Cincinnati Children's Hospital Medical Center Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH
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