In:
Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 15, No. Suppl_1 ( 2022-05)
Abstract:
Background: Neonates with cyanotic congenital heart disease (CHD) and ductal-dependent pulmonary blood flow require a life-saving intervention soon after birth. The modified Blalock-Thomas-Taussig shunt (BTTS) is a well-established palliative intervention for securing pulmonary blood flow. More recently, development of the ductus arteriosus stent (DAS) has presented an alternative option. There is no consensus regarding the optimal strategy. Observational studies have not demonstrated clear differences in mortality or unplanned reintervention for cyanosis between DAS and BTTS, with DAS associated with shorter length of stay but greater likelihood of other reinterventions. Objective: To examine trends in DAS versus BTTS utilization in a cohort of US neonates with cyanotic CHD. Methods: An observational study of neonates undergoing DAS or BTTS within 30 days of birth discharged 1/2017-12/2020 was performed using the Pediatric Health Information Systems database. Mixed-effects multivariate regression was used to adjust for patient characteristics and center-level covariance. Results: A total of 2143 subjects from 39 centers were studied (29% DAS). The proportion of DAS increased over the study period (PANEL A). Prematurity (OR 2.0, p 〈 0.001), genetic anomalies (OR 1.2, p=0.02), and pulmonary atresia (OR 2.1, p 〈 0.001) were associated with increased odds of performing DAS over of BTTS. Adjusting for measurable confounders, the odds of DAS increased significantly over time (OR 1.3 per year, p 〈 0.001, PANEL B). However, there was significant intra-hospital practice variation not explained by differences in case-mix (MOR 3.48, 95% CI 2.58-5.15). Conclusion: Utilization of DAS is increasing overall. However, there remains significant variability in practice across US pediatric hospitals. Studies guiding optimal patient selection for DAS and BTTS are warranted.
Type of Medium:
Online Resource
ISSN:
1941-7713
,
1941-7705
DOI:
10.1161/circoutcomes.15.suppl_1.45
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2022
detail.hit.zdb_id:
2453882-6
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