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Influence of weight at the time of first palliation on survival in patients with a single ventricle

Published online by Cambridge University Press:  27 June 2017

Sushitha Surendran ,
T. K. Susheel Kumar ,
Ben Tansey ,
Jerry Allen ,
David Zurakowski ,
Umar Boston ,
Samir H. Shah  and
Christopher J. Knott-Craig
Sushitha Surendran*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
T. K. Susheel Kumar
Affiliation:
Department of Pediatric Cardiothoracic Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
Ben Tansey
Affiliation:
Department of Pediatric Cardiothoracic Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
Jerry Allen
Affiliation:
Department of Pediatric Cardiothoracic Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
David Zurakowski
Affiliation:
Departments of Anesthesia and Biostatistics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
Umar Boston
Affiliation:
Department of Pediatric Cardiothoracic Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
Samir H. Shah
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
Christopher J. Knott-Craig
Affiliation:
Department of Pediatric Cardiothoracic Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
*
Correspondence to: S. Surendran, MD, Pediatric Cardiology Fellow, LeBonheur Children’s Hospital, 49 N. Dunlap St., Memphis, TN 38103, United States of America. Tel: 646 912 2679; Fax: 901 587 5970; E-mail: drssurendran@gmail.com
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Abstract

Background

Numerous advances in surgical techniques and understanding of single-ventricle physiology have resulted in improved survival. We sought to determine the influence of various demographic, perioperative, and patient-specific factors on the survival of single-ventricle patients following stage 1 palliation at our institution.

Methods

We conducted a retrospective study of all single-ventricle patients who had undergone staged palliation at our institution over an 8-year period. Data were collected from the Society of Thoracic Surgeons Congenital Heart Surgery database and from patient charts. Information on age, weight at stage 1 palliation, prematurity, genetic abnormalities, non-cardiac anomalies, ventricular dominance, and type of palliation was collected. Information on mortality and unplanned reinterventions was also collected.

Results

A total of 72 patients underwent stage 1 palliation over an 8-year period. There were 12 deaths before and one death after stage 2 palliation. There was no hospital mortality following Glenn or Fontan procedures. On univariate analysis, low weight at the time of stage 1 palliation and prematurity were found to be risk factors for mortality following stage 1 palliation. However, multivariable Cox regression analysis revealed weight at stage 1 palliation to be a strong predictor of mortality. The type of stage 1 palliation did not have any influence on the outcome. No difference in survival was noted following the Glenn procedure.

Conclusion

Low weight has a deleterious impact on survival following stage 1 palliation. This is mitigated by stage 2 palliation. The type of stage 1 palliation itself has no bearing on the outcome.

Keywords

Single ventriclelow weightstage 1 palliationmortality
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1778 - 1785
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Copyright
© Cambridge University Press 2017 

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References

1. Fontan, F, Baudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240–248.Google Scholar
2. Alsoufi, B, McCracken, C, Ehrlich, A, et al. Single ventricle palliation in low weight patients is associated with worse early and midterm outcomes. Ann Thorac Surg 2015; 99: 668–676.Google Scholar
3. Patel, A, Hickey, E, Mavroudis, C, et al. Impact of noncardiac congenital and genetic abnormalities on outcomes in hypoplastic left heart syndrome. Annals Thorac Surg 2010; 89: 1805–1813; discussion 13–4.Google Scholar
4. Costello, JM, Pasquali, SK, Jacobs, JP, et al. Gestational age at birth and outcomes after neonatal cardiac surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Circulation 2014; 129: 2511–2517.Google Scholar
5. Alsoufi, B, Manlhiot, C, Al-Ahmadi, M, et al. Older children at the time of the Norwood operation have ongoing mortality vulnerability that continues after cavopulmonary connection. J Thorac Cardiovasc Surg 2011; 142: 142–147; e2.Google Scholar
6. Zhou, X-h, McClish, DK, Obuchowski, NA, ebrary Inc. Statistical methods in diagnostic medicine, In: Wiley Series in Probability and Statistics, Wiley,: Hoboken, NJ. 2011 13–36.Google Scholar
7. Williams, RV, Ravishankar, C, Zak, V, et al. Birth weight and prematurity in infants with single ventricle physiology: pediatric heart network infant single ventricle trial screened population. Congenit Heart Dis 2010; 5: 96–103.CrossRefGoogle ScholarPubMed
8. Rosenthal, GL. Patterns of prenatal growth among infants with cardiovascular malformations: possible fetal hemodynamic effects. Am J Epidemiol 1996; 143: 505–513.Google Scholar
9. Jenkins, KJ, Gauvreau, K, Newburger, JW, Spray, TL, Moller, JH, Iezzoni, LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110–118.Google Scholar
10. Costello, JM, Polito, A, Brown, DW, et al. Birth before 39 weeks’ gestation is associated with worse outcomes in neonates with heart disease. Pediatrics 2010; 126: 277–284.Google Scholar
11. Tita, AT, Landon, MB, Spong, CY, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. New Engl J Med 2009; 360: 111–120.Google Scholar
12. Alsoufi, B, Gillespie, S, Mahle, WT, et al. The effect of noncardiac and genetic abnormalities on outcomes following neonatal congenital heart surgery. Semin Thorac Cardiovasc Surg 2016; 28: 105–114.Google Scholar
13. Tabbutt, S, Ghanayem, N, Ravishankar, C, et al. Risk factors for hospital morbidity and mortality after the Norwood procedure: a report from the Pediatric Heart Network Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg 2012; 144: 882–895.Google Scholar
14. Alsoufi, B, Gillespie, S, Kogon, B, et al. Results of palliation with an initial modified Blalock Taussig shunt in neonates with single ventricle anomalies associated with restrictive pulmonary blood flow. Ann Thorac Surg 2015; 99: 1639–1646; discussion 46–7.CrossRefGoogle ScholarPubMed
15. Alsoufi, B, Manlhiot, C, Ehrlich, A, et al. Results of palliation with an initial pulmonary artery band in patients with single ventricle associated with unrestricted pulmonary blood flow. J Thorac Cardiovasc Surg 2015; 149: 213–220.Google Scholar
16. Reddy, VM, McElhinney, DB, Sagrado, T, Parry, AJ, Teitel, DF, Hanley, FL. Results of 102 cases of complete repair of congenital heart defects in patients weighing 700 to 2500 grams. J Thorac Cardiovasc Surg 1999; 117: 324–331.Google Scholar
17. Oppido, G, Pace Napoleone, C, Formigari, R, et al. Outcome of cardiac surgery in low birth weight and premature infants. Eur J Cardiothorac Surg 2004; 26: 44–53.CrossRefGoogle ScholarPubMed
18. Curzon, CL, Milford-Beland, S, Li, JS, et al. Cardiac surgery in infants with low birth weight is associated with increased mortality: analysis of the Society of Thoracic Surgeons Congenital Heart Database. J Thorac Cardiovasc Surg 2008; 135: 546–551.Google Scholar
19. Gelehrter, S, Fifer, CG, Armstrong, A, Hirsch, J, Gajarski, R. Outcomes of hypoplastic left heart syndrome in low-birth-weight patients. Pediatr Cardiol. 2011; 32: 1175–1181.Google Scholar
20. Pizarro, C, Davis, DA, Galantowicz, ME, Munro, H, Gidding, SS, Norwood, WI. Stage I palliation for hypoplastic left heart syndrome in low birth weight neonates: can we justify it? Eur J Cardiothorac Surg 2002; 21: 716–720.CrossRefGoogle Scholar
21. Myers, JW, Ghanayem, NS, Cao, Y, et al. Outcomes of systemic to pulmonary artery shunts in patients weighing less than 3 kg: analysis of shunt type, size, and surgical approach. J Thorac Cardiovasc Surg 2014; 147: 672–677.CrossRefGoogle ScholarPubMed
22. Petrucci, O, O’Brien, SM, Jacobs, ML, Jacobs, JP, Manning, PB, Eghtesady, P. Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure. Ann Thorac Surg 2011; 92: 642–651; discussion 51–2.Google Scholar
23. Alsoufi, B, Manlhiot, C, Mahle, WT, et al. Low-weight infants are at increased mortality risk after palliative or corrective cardiac surgery. J Thorac Cardiovasc Surg 2014; 148: 2508–2514; e1.CrossRefGoogle ScholarPubMed
24. Ades, A, Johnson, BA, Berger, S. Management of low birth weight infants with congenital heart disease. Clin Perinatol 2005; 32: 999–1015; x–xi.Google Scholar
25. Chang, AC, Hanley, FL, Lock, JE, Castaneda, AR, Wessel, DL. Management and outcome of low birth weight neonates with congenital heart disease. J Pediatr 1994; 124: 461–466.Google Scholar