Skip to main content Accessibility help
×
Home
Hostname: page-component-7ccbd9845f-9nx8b Total loading time: 0.305 Render date: 2023-01-29T20:23:25.622Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Younger age remains a risk factor for prolonged length of stay after bidirectional cavopulmonary anastomosis

Published online by Cambridge University Press:  30 January 2019

Andrew M. Koth*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Claudia A. Algaze
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Charlotte Sakarovitch
Affiliation:
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Jin Long
Affiliation:
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Komal Kamra
Affiliation:
Department of Anesthesia, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Gail E. Wright
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Bambi Alexander-Banys
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Katsuhide Maeda
Affiliation:
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Andrew Y. Shin
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
*
Author for correspondence: Andrew Koth, Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA. E-mail: akoth@stanford.edu

Abstract

Objective

This study sets out to determine the influence of age at the time of surgery as a risk factor for post-operative length of stay after bidirectional cavopulmonary anastomosis.

Methods

All patients undergoing a Glenn procedure between January 2010 and July 2015 were included in this retrospective cohort study. Demographic data were examined. Standard descriptive statistics was used. A univariable analysis was conducted using the appropriate test based on data distribution. A propensity score for balancing the group difference was included in the multi-variable analysis, which was then completed using predictors from the univariable analysis that achieved significance of p<0.1.

Results

Over the study period, 50 patients met the inclusion criteria. Patients were separated into two cohorts of ⩾4 months (28 patients) and <4 months (22 patients). Other than height and weight, the two cohorts were indistinguishable in their pre-operative saturation, medications, catheterisation haemodynamics, atrioventricular valve regurgitation, and ventricular function. After adjusting group differences, younger age was associated with longer post-operative length of hospitalisation – adjusted mean 15 (±2.53) versus 8 (±2.15) days (p=0.03). In a multi-variable regression analysis, in addition to ventricular dysfunction (β coefficient=8.8, p=0.05), Glenn procedures performed before 4 months were independently associated with longer length of stay (β coefficient=−6.9, p=0.03).

Conclusion

We found that Glenn procedures performed after 4 months of age had shorter post-operative length of stay when compared to a younger cohort. These findings suggest that balancing timing of surgery to decrease the inter-stage period should take into consideration differences in post-operative recovery with earlier operations.

Type
Original Article
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Cite this article: Koth AM, Algaze CA, Sakarovitch C, Long J, Kamra K, Wright GE, Alexander-Banys B, Maeda K, Shin AY. (2019) Younger age remains a risk factor for prolonged length of stay after bidirectional cavopulmonary anastomosis. Cardiology in the Young29: 369–374. doi: 10.1017/S1047951118002470

References

1. Lamberti, JJ, Spicer, RL, Waldman, JD, et al. The bidirectional cavopulmonary shunt. J Thorac Cardiovasc Surg 1990; 100: 2229; discussion 29,30.Google ScholarPubMed
2. di Carlo, D, Williams, WG, Freedom, RM, Trusler, GA, Rowe, RD. The role of cava-pulmonary (Glenn) anastomosis in the palliative treatment of congenital heart disease. J Thorac Cardiovasc Surg 1982; 83: 437442.Google ScholarPubMed
3. Jaquiss, RD, Ghanayem, NS, Hoffman, GM, et al. Early cavopulmonary anastomosis in very young infants after the Norwood procedure: impact on oxygenation, resource utilization, and mortality. J Thorac Cardiovasc Surg 2004; 127: 982989.CrossRefGoogle ScholarPubMed
4. Ashburn, DA, Blackstone, EH, Wells, WJ, et al. Determinants of mortality and type of repair in neonates with pulmonary atresia and intact ventricular septum. J Thorac Cardiovasc Surg 2004; 127: 10001007; discussion 1007,1008.10.1016/j.jtcvs.2003.11.057CrossRefGoogle ScholarPubMed
5. Ghanayem, NS, Tweddell, JS, Hoffman, GM, Mussatto, K, Jaquiss, RD. Optimal timing of the second stage of palliation for hypoplastic left heart syndrome facilitated through home monitoring, and the results of early cavopulmonary anastomosis. Cardiol Young 2006; 16 (Suppl 1): 6166.10.1017/S1047951105002349CrossRefGoogle ScholarPubMed
6. Meza, JM, Hickey, E, McCrindle, B, et al. The optimal timing of stage-2-palliation after the Norwood operation. Ann Thorac Surg 2018; 105: 193199.CrossRefGoogle ScholarPubMed
7. Meza, JM, Hickey, EJ, Blackstone, EH, et al. The optimal timing of stage 2 palliation for hypoplastic left heart syndrome: an analysis of the pediatric heart network single ventricle reconstruction trial public data set. Circulation 2017; 136: 17371748.CrossRefGoogle ScholarPubMed
8. Aeba, R, Katogi, T, Kashima, I, Omoto, T, Kawada, S, Omae, K. Factors influencing arterial oxygenation early after bidirectional cavopulmonary shunt without additional sources of pulmonary blood flow. J Thorac Cardiovasc Surg 2000; 120: 589595.CrossRefGoogle ScholarPubMed
9. Lee, TM, Aiyagari, R, Hirsch, JC, Ohye, RG, Bove, EL, Devaney, EJ. Risk factor analysis for second-stage palliation of single ventricle anatomy. Ann Thorac Surg 2012; 93: 614618; discussion 619.10.1016/j.athoracsur.2011.10.012CrossRefGoogle ScholarPubMed
10. Hansen, JH, Uebing, A, Furck, AK, et al. Risk factors for adverse outcome after superior cavopulmonary anastomosis for hypoplastic left heart syndrome. Eur J Cardiothorac Surg 2011; 40: e43e49.CrossRefGoogle ScholarPubMed
11. Petrucci, O, Khoury, PR, Manning, PB, Eghtesady, P. Outcomes of the bidirectional Glenn procedure in patients less than 3 months of age. J Thorac Cardiovasc Surg 2010; 139: 562568.10.1016/j.jtcvs.2009.08.025CrossRefGoogle ScholarPubMed
12. Baker-Smith, CM, Goldberg, SW, Rosenthal, GL. Predictors of prolonged hospital length of stay following stage ii palliation of hypoplastic left heart syndrome (and variants): analysis of the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) database. Pediatr Cardiol 2015; 36: 16301641.10.1007/s00246-015-1208-3CrossRefGoogle ScholarPubMed
13. Siehr, SL, Norris, JK, Bushnell, JA, et al. Home monitoring program reduces interstage mortality after the modified Norwood procedure. J Thorac Cardiovasc Surg 2014; 147: 718723.e1.CrossRefGoogle ScholarPubMed
14. Reddy, VM, Liddicoat, JR, Hanley, FL. Primary bidirectional superior cavopulmonary shunt in infants between 1 and 4 months of age. Ann Thorac Surg 1995; 59: 11201125; discussion 1125,1126.CrossRefGoogle ScholarPubMed
15. Reddy, VM, McElhinney, DB, Moore, P, Haas, GS, Hanley, FL. Outcomes after bidirectional cavopulmonary shunt in infants less than 6 months old. J Am Coll Cardiol 1997; 29: 13651370.10.1016/S0735-1097(97)00068-5CrossRefGoogle ScholarPubMed
16. Anderson, JB, Beekman, RH 3rd, Kugler, JD, et al. Improvement in interstage survival in a national pediatric cardiology learning network. Circ Cardiovasc Qual Outcomes 2015; 8: 428436.10.1161/CIRCOUTCOMES.115.001956CrossRefGoogle Scholar
17. Anderson, JB, Beekman, RH 3rd, Border, WL, et al. Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. J Thorac Cardiovasc Surg 2009; 138: 397404.e1.CrossRefGoogle Scholar
18. Anderson, JB, Beekman, RH 3rd, Eghtesady, P, et al. Predictors of poor weight gain in infants with a single ventricle. J Pediatr 2010; 157: 407413.e1.CrossRefGoogle ScholarPubMed
19. Meza, JM, Jaquiss, RD, Anderson, BR, et al. Current practices in the timing of stage 2 palliation. World J Pediatr Congenit Heart Surg 2017; 8: 135141.CrossRefGoogle ScholarPubMed
20. Alexander-Banys, B, Axelrod, DM, Siehr, SL, Wright, GE. Interstage Nutritional Interventions Improve Growth and Shorten Length of Stay in Norwood Patients Undergoing Glenn at Four Months of Age. Pediatric Cardiac Intensive Care Society Meeting, Stanford University, 2014.Google Scholar
2
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Younger age remains a risk factor for prolonged length of stay after bidirectional cavopulmonary anastomosis
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Younger age remains a risk factor for prolonged length of stay after bidirectional cavopulmonary anastomosis
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Younger age remains a risk factor for prolonged length of stay after bidirectional cavopulmonary anastomosis
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *