Abstract 9906: Early Pulmonary Artery Banding Improves the Long-term Survival in Trisomy 18 Infants: A Receiver Operating Characteristic Curve Analysis

Introduction:Trisomy 18 (T18) is a genetic diagnosis often associated with cardiac malformations. Several recent studies have reported that cardiac interventions improve the survival of T18 infants; however, none have described the optimal age for performing pulmonary artery banding (PAB).Purpose:We investigated the cut-off age for performing PAB, as we have empirically observed that T18 infants who undergo PAB beyond 30 days of life have a relatively poor prognosis.Methods:We reviewed the detailed clinical information of T18 patients at our institute between July 2004 and December 2018. The area under the receiver operating characteristic (ROC) curve (AUC) was used to identify the optimal cut-off age for PAB to predict the one- and five-year survival, and the long-term survival was assessed with the Kaplan-Meier method.Results:A total of 110 infants were diagnosed with T18 at our hospital, and 51 of them underwent PAB, not achieving intracardiac repair. The PAB cases included 34 cases of PAB with patent ductus arteriosus closure, 8 with isolated PAB, 7 with bilateral PAB, and 2 with coarctectomy. The median age at PAB was 29 days old (range, 6-190 days). The age at PAB was younger in alive patients than in dead patients at 1 and 5 years old (P=0.093 and 0.107, respectively). The ROC analysis showed that the optimal cut-off age for PAB was 33 days old for the 5-year survival (sensitivity 80% and specificity 80%, AUC: 0.740) and 42 days old for the 1-year survival (sensitivity 75% and specificity 56%, AUC: 0.593). The 5-year survival rates were 19.8% and 66.5% in PAB patients >33 and ?33 days old, respectively (Log-rank, P=0.046).Conclusions:This is the first study to analyze the optimal age of PAB using the ROC method. Our findings suggest that the optimal age of PAB in T18 infants was ?33 days old if possible, or 42 days old at the latest to improve the long-term survival.