108INITIAL MANAGEMENT OF PULMONARY BLOOD FLOW IS ASSOCIATED WITH LATE OUTCOMES IN TRICUSPID ATRESIA

Objectives: To determine the association between survival and surgical management of pulmonary blood flow (PBF) at index procedure in tricuspid atresia (TA). Methods: Infants with TA (n = 303) were enrolled from 34 institutions (1999–2013). Among infants with surgical intervention (n = 302), the index procedures included Blalock-Taussig shunt (mBT; n = 189, 62%), pulmonary artery banding (PAB; n = 50, 17%) or superior cavopulmonary connection (SCPC; n = 63, 21%). Parametric multiphase risk-adjusted models were used to analyse competing outcomes. Results: Risk-adjusted 1-year survival was lower after mBT (90%) versus PAB (97%) or SCPC (97%) (P = 0.04). Poor survival without SCPC after mBT was associated with a lower immediate post-procedure (prior to extubation) oxygen saturation (Fig. 1). Post-mBT survival was also significantly lower when the ductus remained open post- procedure (n = 7; 97% vs 76%; P = 0.02). mBT origin from the subclavian artery trended toward worse survival than origin from the innominate (IA) (87% vs 94%; P = 0.1). Conclusion: TA patients with mBT represent a high-risk subgroup. Through mechanisms not fully understood, concomitant PT intervention at mBT is associated with increased risk of death which continues after transition to SCPC.