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Dead space fractions in neonates following first-stage palliation for hypoplastic left heart syndrome

  • Pilar Anton-Martin (a1), Rhucha Joshi (a2), Mounica Rao (a2), Sindhu Pandurangi (a2), Chasity Wellnitz (a3), Paul Kang (a4), John J. Nigro (a3), Daniel Velez (a3) and Brigham C. Willis (a5) (a6)...



(1) To characterise changes in dead space fraction during the first 120 post-operative hours in neonates undergoing stage 1 palliation for hypoplastic left heart syndrome, including hybrid procedure; (2) to document whether dead space fraction varied by shunt type (Blalock–Taussig shunt and Sano) and hybrid procedure; and (3) to determine the association between dead space fraction and outcomes.


Retrospective chart review in neonates undergoing stage 1 palliation for hypoplastic left heart syndrome in a cardiac intensive care unit over a consecutive 30-month period. A linear mixed model was used to determine the differences in dead space over time. Multivariable linear regression and a multivariable linear mixed model were used to assess the association between dead space and outcomes at different time points and over time, respectively.


Thirty-four neonates received either a Blalock–Taussig shunt (20.5%), Sano shunt (59%), or hybrid procedure (20.5%). Hospital mortality was 8.8%. Dead space fractions in patients undergoing the hybrid procedure were significantly lower on day 1 (p = 0.01) and day 2 (p = 0.02) and increased over time. A dead space fraction >0.6 on post-operative days 3–5 was significantly associated with decreased duration of mechanical ventilation in all surgical groups (p < 0.001).


Dead space fraction >0.6 on post-operative days 3–5 was associated with lower duration of mechanical ventilation in all surgical groups. A more comprehensive, prospective assessment of dead space in this delicate patient population would likely be beneficial in improving outcomes.


Corresponding author

Author for correspondence: Pilar Anton-Martin, MD, PhD, Department of Medical Education, Phoenix Children’s Hospital, 1919 E. Thomas Rd., Phoenix, AZ 85016, USA. Tel: (602) 933-0768; Fax: (602) 933-2321; E-mail:


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