Abstract 13006: Association of Changes in Interstage Monitoring Practices and Transcatheter Intervention for Recurrent Coarctation Following the Norwood Operation

Introduction: Intensive interstage monitoring has been associated with lower mortality between the Norwood operation and superior cavopulmonary connection. This may be due to early identification of residual anatomic lesions like recoarctation before lasting harm occurs. Methods: Neonates undergoing a Norwood and followed interstage at a single center from 1/1/2005-9/18/2020 were studied. The exposure was Norwood date divided into 3 eras: 1. pre-interstage monitoring; 2. early era of monitoring; 3. current era. We evaluated the association of era and likelihood of hemodynamic insult (≥moderate ventricular dysfunction/AV valve regurgitation, initiation/escalation of vasoactive/respiratory support, cardiac arrest preceding cath, or interstage death with coarctation on autopsy) in subjects with recoarctation. We also analyzed whether era was associated with technical success in transcatheter recoarctation interventions, procedural major adverse events, and transplant-free survival. Results: 483 subjects were studied, with 22% (n=106) treated for interstage recoarctation. Number of catheterizations per Norwood increased ( p =0.005) with no significant change in the proportion of subjects with recoarctation ( p =0.36). There was a lower likelihood of hemodynamic insult in subjects with recoarctation after institution of interstage monitoring (63% Era 1, 38% Era 3), but this was not statistically significant ( p =0.06). The proportion of subjects with ventricular dysfunction at intervention decreased significantly ( p =0.002). Rates of technical success, procedural major adverse events, and transplant-free survival did not differ ( p >0.05). Conclusions: Interstage monitoring was associated with increased referral for catheterization but was balanced by a decreased likelihood of hemodynamic insult in subjects with recoarctation. Future study is needed to optimize interstage monitoring strategies for early detection of recoarctation.