First name
Michael
Last name
Kelleman

Title

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.

Year of Publication

2020

Number of Pages

e013807

Date Published

2020 Jan 07

ISSN Number

2047-9980

Abstract

<p><strong>Background</strong> In infants with ductal-dependent pulmonary blood flow, the impact of palliation strategy on interstage growth and feeding regimen is unknown.</p>

<p><strong>Methods and Results</strong> 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 -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 (=0.051). After adjustment, change in weight-for-age -score did not differ between groups over the entire interstage. However, change in weight-for-age -score favored PDA stent during the inpatient interstage (=0.005) and BTS during the outpatient interstage (=0.032). At initial hospital discharge, PDA stent treatment was associated with all oral feeds (&lt;0.001) and absence of feeding-related medications (=0.002). Subgroup analysis revealed that 2V but not 1V patients demonstrated significant increase in weight-for-age -score. In the 2V cohort, feeding-related readmissions were more common in the BTS group (=0.008).</p>

<p><strong>Conclusions </strong>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.</p>

DOI

10.1161/JAHA.119.013807

Alternate Title

J Am Heart Assoc

PMID

31852418

Title

Comprehensive comparative outcomes in children with congenital heart disease: The rationale for the Congenital Catheterization Research Collaborative.

Year of Publication

2019

Number of Pages

341-349

Date Published

2019 May

ISSN Number

1747-0803

Abstract

<p>Clinical research in the treatment of patients with congenital heart disease (CHD) is limited by the wide variety of CHD manifestations and therapeutic options as well as the generally low incidence of CHD. The availability of comprehensive, contemporary outcomes studies is therefore limited. This inadequacy may result in a lack of data-driven medical decision making. In 2013, clinician scientists at two centers began a research collaboration, the Congenital Catheterization Research Collaborative (CCRC). Over time, the CCRC has grown to include nine cardiac centers from across the United States, with a common data coordinating center. The CCRC seeks to generate high-quality, contemporary, statistically robust, and generalizable outcomes research which can help address important clinical questions in the treatment of CHD. To date, the CCRC has reported on multicenter outcomes in: neonates with congenital aortic stenosis, infants undergoing right ventricular decompression for pulmonary atresia and intact ventricular septum, and infants with ductal-dependent pulmonary blood flow. The CCRC has been successful at leveraging large multicenter cohorts of patients in a contemporary period to perform comparative studies. In the future, the CCRC plans to continue to perform hypothesis-driven retrospective and prospective observational studies of CHD populations where controversy exists or where novel interventions or therapies have emerged. Quality improvement efforts including lesion-specific registry development may be an additional potential future target.</p>

DOI

10.1111/chd.12737

Alternate Title

Congenit Heart Dis

PMID

31183955

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