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Impact of Treatment Strategy on Outcomes in Isolated Pulmonary Artery of Ductal Origin.
- Source :
-
Pediatric cardiology [Pediatr Cardiol] 2021 Mar; Vol. 42 (3), pp. 533-542. Date of Electronic Publication: 2021 Jan 04. - Publication Year :
- 2021
-
Abstract
- Isolated pulmonary artery (PA) of ductal origin (IPADO) is a rare cardiac defect which requires surgical repair, with or without preceding palliation. We sought to determine the impact of treatment strategy on outcomes. Retrospective study of consecutive patients with IPADO that underwent staged or primary repair from 1/05 to 9/16 at 6 Congenital Cardiac Research Collaborative centers. Patients with single ventricle physiology, major aortopulmonary collaterals, or bilateral IPADO were excluded. Primary outcome was isolated PA z-score at late follow-up. Secondary outcomes included PA symmetry index (isolated:confluent PA diameter) and reintervention burden. Propensity score adjustment was used to account for baseline differences. Of 60 patients in the study cohort, 26 (43%) underwent staged and 34 (57%) primary repair. The staged and primary repair groups differed in weight at diagnosis and presence of other heart disease but not in baseline PA dimensions. Staged patients underwent ductal stent (n = 16) or surgical shunt (n = 10) placement followed by repair at 210 vs. 21 days in the primary repair group (p < 0.001). At median follow-up of 4.5 years post-repair, after adjustment, isolated PA z-score (- 0.74 [- 1.75, - 0.26] vs. - 1.95 [- 2.91, - 1.59], p = 0.012) and PA symmetry index (0.81 [0.49, 1.0] vs. 0.55 [0.48, 0.69], p = 0.042) significantly favored the staged repair group. Freedom from PA reintervention was not different between groups (adjusted HR 0.78 [0.41, 1.48]; p = 0.445). A staged approach to repair of IPADO is associated with superior isolated PA size and symmetry at late follow-up. Consideration should be given to initial palliation in IPADO patients, when feasible.
- Subjects :
- Cardiac Catheterization methods
Ductus Arteriosus, Patent surgery
Female
Humans
Infant
Infant, Newborn
Male
Palliative Care methods
Reoperation methods
Retrospective Studies
Stents
Treatment Outcome
Cardiac Surgical Procedures methods
Heart Defects, Congenital surgery
Pulmonary Artery abnormalities
Pulmonary Artery surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1432-1971
- Volume :
- 42
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Pediatric cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 33394118
- Full Text :
- https://doi.org/10.1007/s00246-020-02511-y