Pirouz Shamszad1, Tal A Gospin2, Borah J Hong2, Emmett D McKenzie3, Christopher J Petit2. 1. Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex. Electronic address: pirouzshamszad@gmail.com. 2. Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex. 3. Division Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
Abstract
BACKGROUND: Infants with hypoplastic left heart syndrome (HLHS) are susceptible to pre-Norwood comorbidities (PCs) and complications. This study aimed to describe the effect of PCs on timing and survival of Norwood palliation (NP). METHODS: A single-center, retrospective review of infants with HLHS who underwent initial NP between 2003 and 2010 was performed. PCs included intact atrial septum, ≥ moderate atrioventricular regurgitation (AVVR), no antenatal diagnosis, mitral stenosis/aortic atresia subtype, genetic abnormality, and prematurity. Complications included pre-NP mechanical ventilation, inotropic support, infection, arrhythmia, and end-organ injury. The primary outcome measure was survival after NP. RESULTS: 113 patients were included with 78 (69%) patients having at least one PC and 61 (78%) of those patients having at least one complication. Patients with PCs underwent NP later than those without PCs (7 vs 6 days, P = .036) as well as when associated with a complication (8 vs 5 days, P < .001). Patients with PCs had similar post-Norwood hospital length of stay (P = .116) except when the PC occurred in conjunction with a complication (28 vs 21 days; P = .015). In-hospital mortality post-NP was 10% and interstage mortality was 15%. On multivariable analysis, ≥ moderate AVVR was associated with increased overall mortality (OR 2.8, 95% CI 1.3-6.2). Age at NP was not associated with mortality (P = .638). CONCLUSIONS: Although PCs are common in infants with HLHS, only ≥ moderate AVVR was associated with increased mortality in this single-center experience. Older age at NP was not a significant risk factor for interstage mortality.
BACKGROUND:Infants with hypoplastic left heart syndrome (HLHS) are susceptible to pre-Norwood comorbidities (PCs) and complications. This study aimed to describe the effect of PCs on timing and survival of Norwood palliation (NP). METHODS: A single-center, retrospective review of infants with HLHS who underwent initial NP between 2003 and 2010 was performed. PCs included intact atrial septum, ≥ moderate atrioventricular regurgitation (AVVR), no antenatal diagnosis, mitral stenosis/aortic atresia subtype, genetic abnormality, and prematurity. Complications included pre-NP mechanical ventilation, inotropic support, infection, arrhythmia, and end-organ injury. The primary outcome measure was survival after NP. RESULTS: 113 patients were included with 78 (69%) patients having at least one PC and 61 (78%) of those patients having at least one complication. Patients with PCs underwent NP later than those without PCs (7 vs 6 days, P = .036) as well as when associated with a complication (8 vs 5 days, P < .001). Patients with PCs had similar post-Norwood hospital length of stay (P = .116) except when the PC occurred in conjunction with a complication (28 vs 21 days; P = .015). In-hospital mortality post-NP was 10% and interstage mortality was 15%. On multivariable analysis, ≥ moderate AVVR was associated with increased overall mortality (OR 2.8, 95% CI 1.3-6.2). Age at NP was not associated with mortality (P = .638). CONCLUSIONS: Although PCs are common in infants with HLHS, only ≥ moderate AVVR was associated with increased mortality in this single-center experience. Older age at NP was not a significant risk factor for interstage mortality.
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