Differences in Cost of Care by Palliation Strategy for Infants With Ductal-Dependent Pulmonary Blood Flow

Goldstein, Bryan H.; O’Byrne, Michael L.; Petit, Christopher J.; Qureshi, Athar M.; Dai, Dingwei; Griffis, Heather; Kelleman, Michael; Mascio, Christopher E.; Shashidharan, Subi; Ligon, R. Allen; Whiteside, Wendy; Wallen, W. Jack; Agrawal, Hitesh; Aggarwal, Varun; Glatz, Andrew C.

doi:10.1161/circinterventions.118.007232

Cited by 35 publications

(28 citation statements)

References 28 publications

(42 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to the inclusion and exclusion criteria, six studies (from 2009 to 2018, involving 757 patients) were included in the analysis [ 16 – 21 ]. Three studies used the same database, and we included only the largest one by Glatz et al for the synthetic analysis [ 20 , 22 , 23 ]. The detailed literature screen steps are shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Relatively, the length of ICU stay and hospital stay were both shorter according to the studies by Glatz et al and Bentham et al [ 20 , 21 ]. Furthermore, Goldtein et al compared the costs for hospitalization and the first year of life between the two groups and found that there were lower costs for patients who received stent implantation [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Arterial duct stent versus surgical shunt for patients with duct-dependent pulmonary circulation: a meta-analysis

Zhou

2021

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Background Both systemic-pulmonary shunt and arterial duct stent could be the palliation of duct-dependent pulmonary circulation. We aimed to compare the safety and efficacy of the two approaches. Methods The PubMed, EMBASE, and Cochrane Library databases were searched through December 2019 for studies comparing stent implantation and surgical shunt in duct-dependent pulmonary circulation. The baseline characteristics included ventricle physiology and cardiac anomaly. The main outcomes were hospital stay and total mortality. Additional outcomes included procedural complications, intensive care unit (ICU) stay, pulmonary artery growth at follow-up, and other indexes. A random- or fixed-effects model was used to summarize the estimates of the mean difference (MD)/risk ratio (RR) with 95% confidence intervals (CIs). Results In total, 757 patients with duct-dependent pulmonary circulation from six studies were included. Pooled estimates of hospital stay (MD, − 4.83; 95% CI − 7.92 to − 1.74; p < 0.05), total mortality (RR 0.44; 95% CI 0.28–0.70; p < 0.05), complications (RR 0.49; 95% CI 0.30–0.81; p < 0.05) and ICU stay (MD, − 4.00; 95% CI − 5.96 to − 2.04; p < 0.05) favored the stent group. Significant differences were found in the proportions of patients with a single ventricle (RR 0.82; 95% CI 0.68–0.98; p < 0.05) or a double ventricle (RR 1.23; 95% CI 1.07–1.41; p < 0.05) between the stent and shunt groups. Additionally, pulmonary artery growth showed no significant differences between the two groups. Conclusion Arterial duct stent appears to have not inferior outcomes of procedural complications, mortality, hospital and ICU stay, and pulmonary artery growth in selected patients compared with a surgical shunt. Trial registration CRD42019147672.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Arterial duct stent versus surgical shunt for patients with duct-dependent pulmonary circulation: a meta-analysis

Zhou

2021

BMC Cardiovasc Disord

View full text Add to dashboard Cite

show abstract

“…PDA stenting remains an important means of palliating infants with cyanotic congenital heart disease with the potential to reduce morbidity and costs of care in this population . To date, there have not been any reports of bronchial compression after PDA stent angioplasty.…”

Section: Resultsmentioning

confidence: 99%

Compression of the left mainstem bronchus by patent ductus arteriosus in neonates under consideration for ductal stenting

Smith

Saul

Goldfarb

et al. 2020

Cathet Cardio Intervent

View full text Add to dashboard Cite

Stent angioplasty of patent ductus arteriosus has been shown to be a viable alternative to operative shunt placement in cyanotic neonates. With broader implementation of this strategy, novel complications are bound to arise. We present a series of cases evaluated for ductal stent angioplasty in which a dilated and torturous ductus arteriosus compressed the left mainstem bronchus. After reviewing our recent experience with ductal stenting and isolated Blalock-Taussig shunts, our best estimate of the incidence of bronchial compression by the dilated ductus is 4.6% (3/64, 95% confidence interval 1.0-12.9%). Awareness of the airway and other nonvascular contents of the thorax is an important consideration prior to ductal stenting.

show abstract

“…Glatz et al 6 reported similar mortality and freedom from unplanned interventions between both methods; however, balanced pulmonary artery growth favored PDA stenting. On the other hand, Goldstein et al 3 reported comparable pulmonary artery growth with no difference in pulmonary artery reconstruction required at the second stage for both groups. Moreover, the cost of care after PDA stenting during the first year of life was lower than equivalent MBTS patients.…”

Section: Introductionmentioning

confidence: 97%

“…2 With the advantage of avoiding potential surgical complications, the use of PDA stenting continues to grow. 3 However, PDA stenting has issues related to vascular access and stent-related complications. 4,5 Few studies have compared the clinical outcomes of PDA stenting and MBTS as first-stage palliation of duct-dependent PBF lesions.…”

Section: Introductionmentioning

confidence: 99%

Patent ductus arteriosus stenting versus modified Blalock–Taussig shunt for palliation of duct‐dependent pulmonary blood flow lesions

Helal

Elmahrouk

Bekheet

et al. 2022

Journal of Cardiac Surgery

View full text Add to dashboard Cite

Background: Patent ductus arteriosus (PDA) stenting is an alternative to modified Blalock-Taussig shunt (MBTS) as first-stage palliation of duct-dependent lesions.The superiority of one approach over the other is still controversial. Our objective was to compare PDA stent versusMBTS for palliation in regard to safety, efficacy, and efficiency. Methods: From 2010 to 2021, 134 patients had first-stage palliation with either PDA stent (n = 83) or MBTS (n = 51). Twenty-seven patients failed the primary treatment and were converted to the other group. The study endpoints were hospital outcomes, interstage reintervention, and concomitant procedures at the second-stage palliation. Results: Patients with PDA stent were significantly younger. The prevalence of antegrade pulmonary blood flow (PBF) was higher in patients who had MBTS and graft thrombosis was higher in the PDA stent. Hospital stay was significantly longer in patients who had MBTS. Predictors of prolonged mechanical ventilation were lowweight, MBTS, and conversion. Intensive care unit stay significantly increased with conversion, low-weight, and antegrade PBF. The interstage intervention was required more frequently in PDA-stent group. Predictors of reintervention were conversion and pulmonary atresia with the intact interventricular septum. Pulmonary artery plasty was required more frequently during the second-stage palliation in PDA-stent group. Conclusion: PDA stent is an alternative to MBTS for first-stage palliation. It is associated with shorter hospital stays and avoidance of surgery at the expense of a high rate of stent thrombosis and interstage reintervention. Conversion increased the risk of the procedure. More studies are needed to determine factors that affect PDA-stent outcomes and patient selection criteria.

show abstract

Differences in Cost of Care by Palliation Strategy for Infants With Ductal-Dependent Pulmonary Blood Flow

Cited by 35 publications

References 28 publications

Arterial duct stent versus surgical shunt for patients with duct-dependent pulmonary circulation: a meta-analysis

Arterial duct stent versus surgical shunt for patients with duct-dependent pulmonary circulation: a meta-analysis

Compression of the left mainstem bronchus by patent ductus arteriosus in neonates under consideration for ductal stenting

Patent ductus arteriosus stenting versus modified Blalock–Taussig shunt for palliation of duct‐dependent pulmonary blood flow lesions

Contact Info

Product

Resources

About