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Are early palliative procedures providing an adequate long-term benefit in young cyanotic infants from developing countries, despite advances in surgery and interventions?

Published online by Cambridge University Press:  16 November 2020

Pramod Sagar Open the ORCID record for Pramod Sagar [Opens in a new window] ,
Kothandam Sivakumar Open the ORCID record for Kothandam Sivakumar [Opens in a new window] ,
Koneru L. Umamaheshwar ,
Bhushan Sonawane ,
Asish R. Mohakud ,
Monica Rajendran ,
Ravi Agarwal ,
Roy Varghese  and
Ejaz Ahamed Sheriff
Pramod Sagar
Affiliation:
Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
Kothandam Sivakumar*
Affiliation:
Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
Koneru L. Umamaheshwar
Affiliation:
Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
Bhushan Sonawane
Affiliation:
Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
Asish R. Mohakud
Affiliation:
Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
Monica Rajendran
Affiliation:
Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
Ravi Agarwal
Affiliation:
Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
Roy Varghese
Affiliation:
Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
Ejaz Ahamed Sheriff
Affiliation:
Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
*
Author for correspondence: Dr K. Sivakumar, MD, DM, Head of Department of Pediatric Cardiology, Madras Medical Mission, 4A Dr J J Nagar, Mogappair, Chennai 600037, India. Tel: +91 9444449966; Fax: +91 4426565859. E-mail: drkumarsiva@hotmail.com
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Abstract

Objectives:

Ductal stents, right ventricular outflow tract stents, and aortopulmonary shunts are used to palliate newborns and infants with reduced pulmonary blood flow. Current long-term outcomes of these palliations from resource-restricted countries are unknown.

Methods:

This single-centre, retrospective, observational study analysed the technical success, immediate and late mortality, re-interventions, and length of palliation in infants ≤5 kg who underwent aortopulmonary shunts, ductal, and pulmonary outflow stents. Patients were grouped by their anatomy.

Results:

There were 69 infants who underwent one of the palliations. Technical success was 90% for aortopulmonary shunts (n = 10), 91% for pulmonary outflow stents (n = 11) and 100% for ductal stents (n = 48). Early mortality within 30 days in 12/69 patients was observed in 20% after shunts, 9% after pulmonary outflow stents, and 19% after ductal stents. Late mortality in 11 patients was seen in 20% after shunts, 18% after outflow stents, and 15% after ductal stents. Seven patients needed re-interventions; two following shunts, one following outflow stent, and four following ductal stents for hypoxia. Among the anatomical groups, 10/12 patients with pulmonary atresia, intact ventricular septum survived after valvotomy and ductal stenting. Survival to Glenn shunt after ductal stent for pulmonary atresia, intact ventricular septum and diminutive right ventricle was very low in two out of eight patients, but very good (100%) for other univentricular hearts. Among 35 patients with biventricular lesions, 22 survived to the next stage.

Conclusions:

Cyanotic infants, despite undergoing technically successful palliation had a high inter-stage mortality irrespective of the type of palliation. Duct stenting in univentricular hearts and in pulmonary atresia with an intact ventricular septum and adequate sized right ventricle tended to have low mortality and better long-term outcome. Completion of biventricular repair after palliation was achieved only in 63% of patients, reflecting unique challenges in developing countries despite advances in intensive care and interventions.

Keywords

Aortopulmonary shuntarterial duct stentingright ventricular outflow tract stentinginter-stage mortalitydeveloping economies
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 3 , March 2021 , pp. 358 - 370
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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