Outcome Predictors in Catheter Interventions for Severe Right Ventricular Outflow Tract Obstructions

Area of Science:

• Pediatric Cardiology
• Interventional Cardiology
• Congenital Heart Disease

Background:

• Transcatheter interventions are standard for critical pulmonary stenosis (CPS) and pulmonary atresia with intact interventricular septum (PA/IVS).
• Predicting outcomes in these complex congenital heart conditions is crucial for patient management.

Purpose of the Study:

• To identify predictors of procedural success and survival in infants with duct-dependent right ventricular outflow tract obstruction.
• To compare outcomes between PA/IVS and CPS groups.

Main Methods:

• Retrospective analysis of 68 PA/IVS and 50 CPS cases (<3 months old) over 10 years.
• Exclusion criteria included tricuspid valve Z-score < -4, right ventricular-dependent coronary circulation, or additional malformations.

Main Results:

• Lower age, weight, and body surface area were linked to procedural failure.
• Weight was the sole predictor of procedural success.
• Weight and lower post-procedural right ventricular pressure independently predicted survival to hospital discharge.
• The CPS group had higher procedural success and survival rates.

Conclusions:

• Advocating for larger balloon-to-pulmonary annulus ratios to reduce right ventricular pressure, potentially aiding right ventricular growth.
• Suggesting ductal stenting for borderline or bipartite right ventricles.
• Weight and post-procedural RV pressure are critical for survival in this population.