Department of Cardiology, Boston Children's Hospital Harvard Medical School Boston MA.
Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital, Harvard Medical School Boston MA.
J Am Heart Assoc. 2023 Sep 5;12(17):e030528. doi: 10.1161/JAHA.123.030528. Epub 2023 Aug 17.
Background Surgical systemic-to-pulmonary artery shunts have been the standard approach to establish stable pulmonary blood flow in neonates with congenital heart disease with ductal-dependent pulmonary blood flow. More recently, transcatheter ductal stents have been performed as an alternative, less invasive intervention. We aimed to characterize trends in the utilization of surgical shunts versus ductal stents and compare associated outcomes. Methods and Results Using data from the Pediatric Health Information System, we retrospectively analyzed neonates with congenital heart disease with ductal-dependent pulmonary blood flow who underwent surgical shunt or ductal stent placement between January 2016 and December 2021. Patients were identified by () diagnosis and procedure codes. The primary outcome was length of hospital stay. Secondary outcomes were reintervention risk and adjusted hospital costs. Of 936 patients included, 65.2% underwent a surgical shunt over the 6-year period. The proportion who underwent ductal stenting increased from 19% to 53.4% from 2016 to 2021. The median adjusted difference in postintervention length of hospital stay was 11 days greater for the surgical shunt cohort (95% CI, 7.2-14.8; <0.001). The adjusted reintervention risks within 3 (odds ratio [OR], 3.37 [95% CI, 1.91-5.95], <0.001) and 6 months (OR, 2.43 [95% CI, 1.62-3.64], <0.001) were significantly greater in the ductal stent group. Median adjusted index hospital costs were $198 300 ($11 6400-$340 000) versus $120 400 ($81 800-$192 400) for the surgical shunt and ductal stent cohorts, respectively (<0.001). Conclusions Ductal stenting has become an increasingly utilized palliative approach to secure pulmonary blood flow in neonates with congenital heart disease with ductal-dependent pulmonary blood flow in the United States. Ductal stenting is associated with decreased length of hospital stay and reduced overall cost for the index hospitalization but with a greater reintervention risk than surgical shunting.
背景 外科体肺动脉分流术一直是建立患有依赖导管的肺血流先天性心脏病新生儿稳定肺血流的标准方法。最近，经导管导管支架已被用作替代的、侵入性较小的介入方法。我们旨在描述外科分流术与导管支架术的应用趋势，并比较相关结果。
方法和结果 使用来自儿科健康信息系统的数据，我们回顾性分析了 2016 年 1 月至 2021 年 12 月期间接受外科分流术或导管支架置入术的患有依赖导管的肺血流先天性心脏病的新生儿患者。患者通过（）诊断和手术代码确定。主要结局是住院时间。次要结局是再干预风险和调整后的住院费用。在 936 名患者中，65.2%在 6 年期间接受了外科分流术。从 2016 年到 2021 年，接受导管支架术的比例从 19%增加到 53.4%。术后住院时间的调整后中位数差异，外科分流术组大 11 天（95%置信区间，7.2-14.8；<0.001）。3 个月（优势比 [OR]，3.37 [95%置信区间，1.91-5.95]，<0.001）和 6 个月（OR，2.43 [95%置信区间，1.62-3.64]，<0.001）内再干预风险显著更高。导管支架组的中位调整后的索引住院费用分别为 198300 美元（116400-340000 美元）和 120400 美元（81800-192400 美元）（<0.001）。
结论 在美国，导管支架术已成为一种越来越多的姑息性方法，用于为患有依赖导管的肺血流的先天性心脏病新生儿提供肺血流。与外科分流术相比，导管支架术与住院时间缩短和指数住院费用降低相关，但再干预风险更高。
