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J Am Heart Assoc. 2020 Jan 7;9(1):e013807. doi: 10.1161/JAHA.119.013807. Epub 2019 Dec 19.

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.

Author information

1
Division of Cardiology Department of Pediatrics Vanderbilt University School of Medicine Nashville TN.
2
Department of Pediatrics The Cardiac Center Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.
3
Lillie Frank Abercrombie Section of Cardiology Department of Pediatrics Texas Children's Hospital Baylor College of Medicine Houston TX.
4
Sibley Heart Center Cardiology Department of Pediatrics Children's Healthcare of Atlanta Emory University School of Medicine Atlanta GA.
5
Division of Cardiology Department of Pediatrics University of California San Francisco School of Medicine San Francisco CA.
6
The Heart Institute Cincinnati Children's Hospital Medical Center Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH.

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.

KEYWORDS:

congenital heart disease; outcomes research; surgery

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