Interstage mortality after the Norwood procedure: Results of the multicenter Single Ventricle Reconstruction trial
For infants with single ventricle malformations undergoing staged repair, interstage mortality is reported at 2% to 20%. The Single Ventricle Reconstruction trial randomized subjects with a single morphologic right ventricle undergoing a Norwood procedure to a modified Blalock–Taussig shunt (MBTS) o...
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| Published in | The Journal of thoracic and cardiovascular surgery Vol. 144; no. 4; pp. 896 - 906 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
New York, NY
Mosby, Inc
01.10.2012
Elsevier |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0022-5223 1097-685X 1085-8687 1097-685X |
| DOI | 10.1016/j.jtcvs.2012.05.020 |
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| Abstract | For infants with single ventricle malformations undergoing staged repair, interstage mortality is reported at 2% to 20%. The Single Ventricle Reconstruction trial randomized subjects with a single morphologic right ventricle undergoing a Norwood procedure to a modified Blalock–Taussig shunt (MBTS) or a right ventricle-to-pulmonary artery shunt (RVPAS). The aim of this analysis was to explore the associations of interstage mortality and shunt type, and demographic, anatomic, and perioperative factors.
Participants in the Single Ventricle Reconstruction trial who survived to discharge after the Norwood procedure were included (n = 426). Interstage mortality was defined as death postdischarge after the Norwood procedure and before the stage II procedure. Univariate analysis and multivariable logistic regression were performed adjusting for site.
Overall interstage mortality was 50 of 426 (12%)—13 of 225 (6%) for RVPAS and 37 of 201 (18%) for MBTS (odds ratio [OR] for MBTS, 3.4; P < .001). When moderate to severe postoperative atrioventricular valve regurgitation (AVVR) was present, interstage mortality was similar between shunt types. Interstage mortality was independently associated with gestational age less than 37 weeks (OR, 3.9; P = .008), Hispanic ethnicity (OR, 2.6; P = .04), aortic atresia/mitral atresia (OR, 2.3; P = .03), greater number of post-Norwood complications (OR, 1.2; P = .006), census block poverty level (P = .003), and MBTS in subjects with no or mild postoperative AVVR (OR, 9.7; P < .001).
Interstage mortality remains high at 12% and is increased with the MBTS compared with the RVPAS if postoperative AVVR is absent or mild. Preterm delivery, anatomic, and socioeconomic factors are also important. Avoiding preterm delivery when possible and close surveillance after Norwood hospitalization for infants with identified risk factors may reduce interstage mortality. |
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| AbstractList | For infants with single ventricle malformations undergoing staged repair, interstage mortality is reported at 2% to 20%. The Single Ventricle Reconstruction trial randomized subjects with a single morphologic right ventricle undergoing a Norwood procedure to a modified Blalock-Taussig shunt (MBTS) or a right ventricle-to-pulmonary artery shunt (RVPAS). The aim of this analysis was to explore the associations of interstage mortality and shunt type, and demographic, anatomic, and perioperative factors.
Participants in the Single Ventricle Reconstruction trial who survived to discharge after the Norwood procedure were included (n = 426). Interstage mortality was defined as death postdischarge after the Norwood procedure and before the stage II procedure. Univariate analysis and multivariable logistic regression were performed adjusting for site.
Overall interstage mortality was 50 of 426 (12%)-13 of 225 (6%) for RVPAS and 37 of 201 (18%) for MBTS (odds ratio [OR] for MBTS, 3.4; P < .001). When moderate to severe postoperative atrioventricular valve regurgitation (AVVR) was present, interstage mortality was similar between shunt types. Interstage mortality was independently associated with gestational age less than 37 weeks (OR, 3.9; P = .008), Hispanic ethnicity (OR, 2.6; P = .04), aortic atresia/mitral atresia (OR, 2.3; P = .03), greater number of post-Norwood complications (OR, 1.2; P = .006), census block poverty level (P = .003), and MBTS in subjects with no or mild postoperative AVVR (OR, 9.7; P < .001).
Interstage mortality remains high at 12% and is increased with the MBTS compared with the RVPAS if postoperative AVVR is absent or mild. Preterm delivery, anatomic, and socioeconomic factors are also important. Avoiding preterm delivery when possible and close surveillance after Norwood hospitalization for infants with identified risk factors may reduce interstage mortality. For infants with single ventricle malformations undergoing staged repair, interstage mortality is reported at 2% to 20%. The Single Ventricle Reconstruction trial randomized subjects with a single morphologic right ventricle undergoing a Norwood procedure to a modified Blalock-Taussig shunt (MBTS) or a right ventricle-to-pulmonary artery shunt (RVPAS). The aim of this analysis was to explore the associations of interstage mortality and shunt type, and demographic, anatomic, and perioperative factors.OBJECTIVEFor infants with single ventricle malformations undergoing staged repair, interstage mortality is reported at 2% to 20%. The Single Ventricle Reconstruction trial randomized subjects with a single morphologic right ventricle undergoing a Norwood procedure to a modified Blalock-Taussig shunt (MBTS) or a right ventricle-to-pulmonary artery shunt (RVPAS). The aim of this analysis was to explore the associations of interstage mortality and shunt type, and demographic, anatomic, and perioperative factors.Participants in the Single Ventricle Reconstruction trial who survived to discharge after the Norwood procedure were included (n = 426). Interstage mortality was defined as death postdischarge after the Norwood procedure and before the stage II procedure. Univariate analysis and multivariable logistic regression were performed adjusting for site.METHODSParticipants in the Single Ventricle Reconstruction trial who survived to discharge after the Norwood procedure were included (n = 426). Interstage mortality was defined as death postdischarge after the Norwood procedure and before the stage II procedure. Univariate analysis and multivariable logistic regression were performed adjusting for site.Overall interstage mortality was 50 of 426 (12%)-13 of 225 (6%) for RVPAS and 37 of 201 (18%) for MBTS (odds ratio [OR] for MBTS, 3.4; P < .001). When moderate to severe postoperative atrioventricular valve regurgitation (AVVR) was present, interstage mortality was similar between shunt types. Interstage mortality was independently associated with gestational age less than 37 weeks (OR, 3.9; P = .008), Hispanic ethnicity (OR, 2.6; P = .04), aortic atresia/mitral atresia (OR, 2.3; P = .03), greater number of post-Norwood complications (OR, 1.2; P = .006), census block poverty level (P = .003), and MBTS in subjects with no or mild postoperative AVVR (OR, 9.7; P < .001).RESULTSOverall interstage mortality was 50 of 426 (12%)-13 of 225 (6%) for RVPAS and 37 of 201 (18%) for MBTS (odds ratio [OR] for MBTS, 3.4; P < .001). When moderate to severe postoperative atrioventricular valve regurgitation (AVVR) was present, interstage mortality was similar between shunt types. Interstage mortality was independently associated with gestational age less than 37 weeks (OR, 3.9; P = .008), Hispanic ethnicity (OR, 2.6; P = .04), aortic atresia/mitral atresia (OR, 2.3; P = .03), greater number of post-Norwood complications (OR, 1.2; P = .006), census block poverty level (P = .003), and MBTS in subjects with no or mild postoperative AVVR (OR, 9.7; P < .001).Interstage mortality remains high at 12% and is increased with the MBTS compared with the RVPAS if postoperative AVVR is absent or mild. Preterm delivery, anatomic, and socioeconomic factors are also important. Avoiding preterm delivery when possible and close surveillance after Norwood hospitalization for infants with identified risk factors may reduce interstage mortality.CONCLUSIONSInterstage mortality remains high at 12% and is increased with the MBTS compared with the RVPAS if postoperative AVVR is absent or mild. Preterm delivery, anatomic, and socioeconomic factors are also important. Avoiding preterm delivery when possible and close surveillance after Norwood hospitalization for infants with identified risk factors may reduce interstage mortality. Objective For infants with single ventricle malformations undergoing staged repair, interstage mortality is reported at 2% to 20%. The Single Ventricle Reconstruction trial randomized subjects with a single morphologic right ventricle undergoing a Norwood procedure to a modified Blalock–Taussig shunt (MBTS) or a right ventricle-to-pulmonary artery shunt (RVPAS). The aim of this analysis was to explore the associations of interstage mortality and shunt type, and demographic, anatomic, and perioperative factors. Methods Participants in the Single Ventricle Reconstruction trial who survived to discharge after the Norwood procedure were included (n = 426). Interstage mortality was defined as death postdischarge after the Norwood procedure and before the stage II procedure. Univariate analysis and multivariable logistic regression were performed adjusting for site. Results Overall interstage mortality was 50 of 426 (12%)—13 of 225 (6%) for RVPAS and 37 of 201 (18%) for MBTS (odds ratio [OR] for MBTS, 3.4; P < .001). When moderate to severe postoperative atrioventricular valve regurgitation (AVVR) was present, interstage mortality was similar between shunt types. Interstage mortality was independently associated with gestational age less than 37 weeks (OR, 3.9; P = .008), Hispanic ethnicity (OR, 2.6; P = .04), aortic atresia/mitral atresia (OR, 2.3; P = .03), greater number of post-Norwood complications (OR, 1.2; P = .006), census block poverty level ( P = .003), and MBTS in subjects with no or mild postoperative AVVR (OR, 9.7; P < .001). Conclusions Interstage mortality remains high at 12% and is increased with the MBTS compared with the RVPAS if postoperative AVVR is absent or mild. Preterm delivery, anatomic, and socioeconomic factors are also important. Avoiding preterm delivery when possible and close surveillance after Norwood hospitalization for infants with identified risk factors may reduce interstage mortality. |
| Author | Frommelt, Peter C. Gruber, Peter J. Hill, Kevin D. Lewis, Alan B. Minich, L. LuAnn Schonbeck, Julie V. Lurito, Karen J. Eghtesady, Pirooz Atz, Andrew M. Tabbutt, Sarah Kaltman, Jonathan R. Ohye, Richard G. Cooper, David S. Schwartz, Steven M. Singh, Rakesh K. Clabby, Martha L. Laussen, Peter C. Allen, Kerstin R. Ghanayem, Nancy S. Goldberg, Caren S. |
| AuthorAffiliation | f Congenital Heart Institute of Florida, St. Petersburg, Fla m Primary Children's Medical Center and the University of Utah, Salt Lake City, Utah c Children's Hospital of Philadelphia, Philadelphia, Pa o Hospital for Sick Children, Toronto, Ontario, Canada b New England Research Institutes, Watertown, Mass i North Carolina Consortium: National Heart, Lung, and Blood Institute, Bethesda, Md k Children's Hospital Los Angeles, Los Angeles, Calif h Duke University, Durham, NC p Columbia University, New York, NY d Medical University of South Carolina, Charleston, SC g Cincinnati Children's Medical Center, Cincinnati, Ohio j Children's Hospital Boston, Boston, Mass n University of Michigan Medical School, Ann Arbor, Mich a Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wis l East Carolina University, Greenville, NC e Emory University, Atlanta, Ga |
| AuthorAffiliation_xml | – name: d Medical University of South Carolina, Charleston, SC – name: n University of Michigan Medical School, Ann Arbor, Mich – name: b New England Research Institutes, Watertown, Mass – name: h Duke University, Durham, NC – name: g Cincinnati Children's Medical Center, Cincinnati, Ohio – name: o Hospital for Sick Children, Toronto, Ontario, Canada – name: c Children's Hospital of Philadelphia, Philadelphia, Pa – name: a Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wis – name: j Children's Hospital Boston, Boston, Mass – name: e Emory University, Atlanta, Ga – name: k Children's Hospital Los Angeles, Los Angeles, Calif – name: f Congenital Heart Institute of Florida, St. Petersburg, Fla – name: p Columbia University, New York, NY – name: i North Carolina Consortium: National Heart, Lung, and Blood Institute, Bethesda, Md – name: m Primary Children's Medical Center and the University of Utah, Salt Lake City, Utah – name: l East Carolina University, Greenville, NC |
| Author_xml | – sequence: 1 givenname: Nancy S. surname: Ghanayem fullname: Ghanayem, Nancy S. email: nancyg@mcw.edu organization: Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wis – sequence: 2 givenname: Kerstin R. surname: Allen fullname: Allen, Kerstin R. organization: New England Research Institutes, Watertown, Mass – sequence: 3 givenname: Sarah surname: Tabbutt fullname: Tabbutt, Sarah organization: Children's Hospital of Philadelphia, Philadelphia, Pa – sequence: 4 givenname: Andrew M. surname: Atz fullname: Atz, Andrew M. organization: Medical University of South Carolina, Charleston, SC – sequence: 5 givenname: Martha L. surname: Clabby fullname: Clabby, Martha L. organization: Emory University, Atlanta, Ga – sequence: 6 givenname: David S. surname: Cooper fullname: Cooper, David S. organization: Congenital Heart Institute of Florida, St Petersburg, Fla – sequence: 7 givenname: Pirooz surname: Eghtesady fullname: Eghtesady, Pirooz organization: Cincinnati Children's Medical Center, Cincinnati, Ohio – sequence: 8 givenname: Peter C. surname: Frommelt fullname: Frommelt, Peter C. organization: Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wis – sequence: 9 givenname: Peter J. surname: Gruber fullname: Gruber, Peter J. organization: Children's Hospital of Philadelphia, Philadelphia, Pa – sequence: 10 givenname: Kevin D. surname: Hill fullname: Hill, Kevin D. organization: Duke University, Durham, NC – sequence: 11 givenname: Jonathan R. surname: Kaltman fullname: Kaltman, Jonathan R. organization: North Carolina Consortium: National Heart, Lung, and Blood Institute, Bethesda, Md – sequence: 12 givenname: Peter C. surname: Laussen fullname: Laussen, Peter C. organization: Children's Hospital Boston, Boston, Mass – sequence: 13 givenname: Alan B. surname: Lewis fullname: Lewis, Alan B. organization: Children's Hospital Los Angeles, Los Angeles, Calif – sequence: 14 givenname: Karen J. surname: Lurito fullname: Lurito, Karen J. organization: East Carolina University, Greenville, NC – sequence: 15 givenname: L. LuAnn surname: Minich fullname: Minich, L. LuAnn organization: Primary Children's Medical Center and the University of Utah, Salt Lake City, Utah – sequence: 16 givenname: Richard G. surname: Ohye fullname: Ohye, Richard G. organization: University of Michigan Medical School, Ann Arbor, Mich – sequence: 17 givenname: Julie V. surname: Schonbeck fullname: Schonbeck, Julie V. organization: New England Research Institutes, Watertown, Mass – sequence: 18 givenname: Steven M. surname: Schwartz fullname: Schwartz, Steven M. organization: Hospital for Sick Children, Toronto, Ontario, Canada – sequence: 19 givenname: Rakesh K. surname: Singh fullname: Singh, Rakesh K. organization: Columbia University, New York, NY – sequence: 20 givenname: Caren S. surname: Goldberg fullname: Goldberg, Caren S. organization: University of Michigan Medical School, Ann Arbor, Mich |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26375553$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/22795436$$D View this record in MEDLINE/PubMed |
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| Copyright | 2012 The American Association for Thoracic Surgery The American Association for Thoracic Surgery 2015 INIST-CNRS Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. Copyright © 2012 by The American Association for Thoracic Surgery 2012 |
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| Keywords | ECMO OR RVEF CPR HLHS SVR AVVR RVESV MBTS BSA RVPAS RVEDV DHCA 20 hypoplastic left heart syndrome right ventricle-to-pulmonary artery shunt deep hypothermic circulatory arrest odds ratio cardiopulmonary resuscitation modified Blalock–Taussig shunt right ventricular end-diastolic volume right ventricular end-systolic volume extracorporeal membrane oxygenation right ventricular ejection fraction atrioventricular valve regurgitation Single Ventricle Reconstruction body surface area Reconstruction Prognosis Multicenter study Mortality Cardiovascular disease Congenital disease Result Heart disease Anesthesia Procedure Single ventricle Circulatory system Cardiology |
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| Notes | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3 Kerstin R. Allen's current affiliation is Infinity Pharmaceuticals, Boston, Mass; Sarah Tabbutt's current affiliation is University of California San Francisco, San Francisco, Calif; Peter J. Gruber's current affiliation is Primary Children's Medical Center and University of Utah, Salt Lake City, Utah; David S. Cooper's and Pirooz Egthesady's current affiliation is Cincinnati Children's Medical Center, Cincinnati, Ohio. |
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| Snippet | For infants with single ventricle malformations undergoing staged repair, interstage mortality is reported at 2% to 20%. The Single Ventricle Reconstruction... Objective For infants with single ventricle malformations undergoing staged repair, interstage mortality is reported at 2% to 20%. The Single Ventricle... |
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| SubjectTerms | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blalock-Taussig Procedure - adverse effects Blalock-Taussig Procedure - mortality Cardiology. Vascular system Cardiothoracic Surgery Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava Heart Heart Defects, Congenital - mortality Heart Defects, Congenital - physiopathology Heart Defects, Congenital - surgery Heart Ventricles - abnormalities Heart Ventricles - physiopathology Heart Ventricles - surgery Hemodynamics Humans Hypoplastic Left Heart Syndrome - mortality Hypoplastic Left Heart Syndrome - physiopathology Hypoplastic Left Heart Syndrome - surgery Infant Mortality Infant, Newborn Kaplan-Meier Estimate Logistic Models Medical sciences Multivariate Analysis North America Norwood Procedures - adverse effects Norwood Procedures - mortality Odds Ratio Pneumology Postoperative Complications - etiology Postoperative Complications - mortality Prospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome Ventricular Function |
| Title | Interstage mortality after the Norwood procedure: Results of the multicenter Single Ventricle Reconstruction trial |
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