Abstract 4138253: Reintervention Burden of Single and Biventricular Palliation of Pulmonary Atresia with Intact Ventricular Septum

Introduction: Pulmonary atresia with intact ventricular septum (PAIVS) patients may proceed down a single (SV) or biventricular (BV) pathway. We evaluated the total interventional burden of both pathways including after either end-state was reached. Hypothesis: SV patients will have more interventions in comparison to BV patients. Goals: Assess the nature of interventions in PAIVS. Methods: Retrospective review of PAIVS patients from 1995-2020 who achieved SV (Fontan completion) or BV (normal saturations with no significant shunts) end-state. Demographic, procedural, and follow-up details were collected. Descriptive statistics were used and Kaplan-Meier analysis of freedom from reintervention was performed. Results: Of 79 patients who reached end-state, 40 (51%) were SV and 39 (49%) were BV. Total median in-hospital time was 48 [31-78] days and 18 [12-35] days for SV and BV (p<0.01). The ratio of in-hospital days to total follow-up was a median of 1.7% [0.9-2.7] for SV and 0.4% [0.3-0.8] for BV (p<0.01). SV and BV cohorts had an overall median of 4 [3-5] and 3 [2-4] interventions, respectively (p<0.01). Interventions and their relationship to end-state are shown in Table 1 . The SV and BV groups achieved end-state at a median of 2.9 [2.3-3.6] and 2.1 [0.2-8.8] years (p=0.01) ( Figure 1A ). Median follow up in years after achieving end-state was similar between groups {7 [2.7-15.8] in SV and 7.4 [4.2-13.4] for BV (p=0.11)}. After end-state, there was no difference in the proportion of patients requiring reinterventions (17 (43%) SV and 12 (31%) BV, p>0.05). Freedom from reintervention at 15-years was 44.1% in the SV group and 64.3% in the BV group (p=0.11) ( Figure 1B) with one late SV death. Conclusions: PAIVS therapy requires multiple interventions to achieve both SV and BV repair. While SV patients undergo more interventions and spend more days in the hospital, reinterventions and 15-year freedom from reintervention were comparable between groups with equivalent follow up.