Our Studies

Neonates with tetralogy of Fallot and symptomatic cyanosis (sTOF) require early intervention. Management strategies include initial palliation (IP) followed by later complete repair (CR) or primary repair (PR). This study aimed to thoroughly compare outcomes between these treatment strategies using propensity score adjustment (PSA) to account for baseline differences between groups. Early mortality, risk exposure and procedural complications were lower in the IP group, but cumulative exposures and reinterventions favored the PR group, suggesting each strategy has potential benefits.

In infants with ductal-dependent pulmonary blood flow (PBF), initial palliation with patent ductus arteriosus stent (DAS) or modified Blalock-Taussig shunt (BTS) have comparable mortality but discrepant hospital length of stay (LOS) and procedural complication rates, which may influence cost. With limited economic impact information of these palliation strategies, this multi-center study compared costs of both palliations discovering advantages for DAS patients over the first year of life due largely to lower room and lab costs.

Congenital aortic valve stenosis is relative common congenital heart lesion, that frequently necessitates transcatheter intervention. The natural history of this lesion has been well defined, as has long-term outcomes following transcatheter balloon aortic valvuloplasty. Less well defined, however, is the relationship between underlying valvular morphology and clinical outcomes. This multi-center retrospective study sought to address this query, and demonstrated that aortic valves with lesser commissural fusion and larger openings have higher rates of leaflet tears, which in turn are associated with the development of aortic insufficiency.

Outcomes following right ventricular (RV) decompression in infants with pulmonary atresia and intact ventricular septum (PA-IVS) vary widely. Descriptions of these outcomes have previously been limited to small single-center studies. In this retrospective study using a large, multi-center, and modern dataset - by far the largest assembled to date - we demonstrated that the severity of pre-intervention tricuspid valve regurgitation, even more so than tricuspid valve annular dimension, was closely related to key clinical outcomes including risk of reintervention and ultimate circulatory status. Current work focuses on technical aspects of the procedure and medium-term echocardiographic follow-up of RV growth parameters.

Newborns with cyanotic congenital heart disease and ductal dependent pulmonary blood flow (PBF) require a durable source of PBF until a more definitive repair or subsequent palliation can be performed. Treatment options include surgically placed systemic to pulmonary artery shunts (typically a Blalock-Taussig or BT shunt) or transcatheter patent ductus arteriosus stent placement (PDA stent). These approaches may be associated with distinct risks and outcomes. This retrospective study sought to compare adjusted procedural and medium-term outcomes following BT shunt or PDA stent placement in a large multi-center dataset, far eclipsing the size of existing datasets addressing this population. We demonstrated that mortality and the risk of unplanned reintervention to treat cyanosis were similar between cohorts, while morbidity, length of stay, and pulmonary artery size and symmetry at the time of repair/palliation all favored the PDA stent group. Current work focuses on the relative economic impact of these distinct strategies, and on evaluation of both somatic and pulmonary arterial growth during the interstage.