Abstract 16167: Comparison of Outcomes at Time of Superior Cavopulmonary Connection Between Single Ventricle Patients With Ductal-Dependent Pulmonary Blood Flow Initially Palliated With Either Blalock-Taussig Shunt or Ductus Arteriosus Stent: Results From the Congenital Catheterization Research Collaborative

Introduction: Patients with single ventricle (SV) anatomy and ductal-dependent pulmonary blood flow may be palliated in the neonatal period with either modified Blalock-Taussig shunt (BTS) or ductus arteriosus stent (DAS). Comparisons of interstage outcomes, hemodynamics, anatomy, and clinical outcomes at the time of superior cavopulmonary connection (SCPC) have not been performed and may differ based upon initial palliation. Methods: Infants with SV anatomy and ductal-dependent pulmonary blood flow palliated with either DAS or BTS from January 2008 to November 2015 were reviewed from the 4 member centers of the Congenital Catheterization Research Collaborative. Interstage outcomes were compared. For those who had SCPC during the follow-up period, pulmonary artery anatomy, hemodynamics, and peri-operative clinical outcomes were compared, adjusted for center and anatomic diagnosis. Results: Thirty-five patients with DAS and 134 patients with BTS were included. At initial palliation, demographic and clinical variables, and pulmonary artery (PA) z-scores were not different. During the interstage period, death, transplant or unplanned reintervention to treat cyanosis occurred in 25.7% of DAS and 35.8% of BTS (adjusted HR = 0.63 (95% CI 0.27 – 1.44), p = 0.27). 23 patients with DAS and 111 patients with BTS underwent SCPC, at which time there were no differences in pre-operative catheterization-derived hemodynamics, including PA pressure, pulmonary vascular resistance and ventricular end-diastolic pressures. However, PA growth was better in the DAS group (median change in Nakata index: 88 mm2/m2 v. 65 mm2/m2, adjusted p =0.04), particularly of the RPA (median change in z-score: 1.57 v. 0.65, adjusted p = 0.042) while LPA growth was similar (median change in z score: 0.75 v. 0.86, adjusted p = 0.4. SCPC intraoperative and post-operative courses were similar. Conclusions: In patients with SV anatomy and ductal-dependent pulmonary blood flow, interstage outcomes, hemodynamics prior to superior cavopulmonary connection, and acute post-operative outcomes were not different based on initial palliative strategy. However, PA growth was better in the DAS group. The longer-term implications of this difference require ongoing study. [ABSTRACT FROM AUTHOR]