Long-term outcomes after intervention for pulmonary atresia with intact ventricular septum.
In: Heart, Jg. 105 (2019-07-01), Heft 13, S. 1007-1013
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Zugriff:
Objective: Pulmonary atresia with intact ventricular septum (PA/IVS) can be treated by various operative and catheter-based interventions. We aim to understand the long-term transplant-free survival of patients with PA/IVS by treatment strategy. Methods: Cohort study from the Pediatric Cardiac Care Consortium, a multi-institutional registry with prospectively acquired outcome data after linkage with the National Death Index and the Organ Procurement and Transplantation Network. Results: Eligible patients underwent neonatal surgery or catheter-based intervention for PA/IVS between 1982 and 2003 (median follow-up of 16.7 years, IQR: 12.6-22.7). Over the study period, 616 patients with PA/IVS underwent one of three initial interventions: aortopulmonary shunt, right ventricular decompression or both. Risk factors for death at initial intervention included earlier birth era (1982-1992), chromosomal abnormality and atresia of one or both coronary ostia. Among survivors of neonatal hospitalisation (n=491), there were 99 deaths (4 post-transplant) and 10 transplants (median age of death or transplant 0.7 years, IQR: 0.3-1.8 years). Definite repair or last-stage palliation was achieved in the form of completed two-ventricle repair (n=201), one-and-a-half ventricle (n=39) or Fontan (n=96). Overall 20-year survival was 66%, but for patients discharged alive after definitive repair, it reached 97.6% for single-ventricle patients, 90.9% for those with one-and-a-half ventricle and 98.0% for those with complete two-ventricle repair (log-rank p=0.052). Conclusions: Transplant-free survival in PA/IVS is poor due to significant infantile and interstage mortality. Survival into early adulthood is excellent for patients reaching completion of their intended path independent of type of repair. [ABSTRACT FROM AUTHOR]
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Titel: |
Long-term outcomes after intervention for pulmonary atresia with intact ventricular septum.
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Autor/in / Beteiligte Person: | Wright, Lydia K. ; Knight, Jessica H. ; Thomas, Amanda S. ; Oster, Matthew E. ; St Louis, James D. ; Kochilas, Lazaros K. |
Zeitschrift: | Heart, Jg. 105 (2019-07-01), Heft 13, S. 1007-1013 |
Veröffentlichung: | 2019 |
Medientyp: | academicJournal |
ISSN: | 1355-6037 (print) |
DOI: | 10.1136/heartjnl-2018-314124 |
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