175 - Trends in the use of percutaneous intervention in congenital heart disease for pediatric patients in California and Florida.

Poster Number: 175
Publication Number: 175.101

Karman Low, CHOC Children's Hospital of Orange County, Long Beach, CA, United States; RUEY-KANG CHANG, University of California, Los Angeles David Geffen School of Medicine, Diamond Bar CA,, CA, United States; Virender K. Rehan, Harbor-UCLA Medical Center, Torrance, CA, United States; Dennys Estevez, Lundquist Institute, Los Angeles, CA, United States; Rie Sakai-Bizmark, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States

Background: Congenital heart diseases (CHD) are the most common birth defects with one-quarter requiring surgical intervention (percutaneous/catheter vs surgical) in the first year of life to prevent cardiac failure and death. The innovation and advancement of catheter-based intervention (CBI) for CHD has changed the approach in managing CHD in pediatric patients. 

Objective: We hypothesize that there is a trend in increased utilization of CBI intervention in managing CHD in pediatric patients. We planned to determine the temporal trend of CBI and surgical repair for atrial septal defect/patent foramen ovale (ASD/PFO), ventricular septal defect (VSD), pulmonary stenosis (PS), and aortic stenosis (AoS) in pediatric patients in California and Florida.

Design/Methods: We utilized State Inpatient Database, and Ambulatory Surgery Datasets from 2005-2017, and used diagnosis and procedure codes to identify patients ≤ 18 years who underwent CBI or surgeries for ASD, AoS, VSD, and PS in California and Florida. Primary outcome was annual incidence of surgical repair and CBI for each CHD subtype. Primary exposure variable was repair type (CBI vs. surgical). Incidence rates were expressed as number of cases per 1,000,000 population. 

Results: In years 2005-2017, 13770 patients underwent surgical repair and 3325 patients CBI. A total of 21,579 procedures were performed, with 84.4% being surgical intervention. Most common surgeries were ASD (13, 393 cases, 79.9% surgical) and VSD (6944 cases, 98% surgical) repairs. In contrast, the AoS (432 cases, 64.6% CBI) and PS (810 cases, 30.9% CBI) repairs were more often CBIs. More white and private insurance patients received CBIs, while surgical repairs were more common in black and public insurance patients.  Overall during the period from 2005 to 2017, CBI procedures doubled (increased by 101.5%). Open surgeries declined by half with a 54.8% decline. For VSD repair CBI increased by 1400%, while surgical repair decreased by 86.7% during this period. CBI repair for AoS tripled by 2010, subsequently increased by 488.8%, while surgical AoS repairs declined by half (-53.3%). Lastly, during the study period, CBI PS repair increased by 4300% and surgical repair declined by 25%.Conclusion(s): For common CHDs (ASD, VSD, AoS, PS), although surgical intervention remain common, CBIs increased considerably between 2005-2017. Overall, during the study period (2005-2017), CBIs doubled, while surgical intervention halved. Studies are needed to determine the impact of this trend on mortality, morbidity, and healthcare utilization cost for common pediatric CHDs.
Table 1 - Patient demographyCBI = catheter-based intervention, ASD = Atrial septal defect, AoS = Aortic stenosis, VSD = Ventricular septal defect, PS = pulmonic stenosis
Figure 1 - Trending for total no of cases/1, 000, 000 population over year 2005-2017 for total cases (ASD+VSD+AoS+PS)CBI = catheter-based intervention, ASD = Atrial septal defect, AoS = Aortic stenosis, VSD = Ventricular septal defect, PS = pulmonic stenosis