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; p. 896
Main Authors: Ghanayem, Nancy S, Allen, Kerstin R, Tabbutt, Sarah, Atz, Andrew M, Clabby, Martha L, Cooper, David S, Eghtesady, Pirooz, Frommelt, Peter C, Gruber, Peter J, Hill, Kevin D, Kaltman, Jonathan R, Laussen, Peter C, Lewis, Alan B, Lurito, Karen J, Minich, L LuAnn, Ohye, Richard G, Schonbeck, Julie V, Schwartz, Steven M, Singh, Rakesh K, Goldberg, Caren S
Format: Journal Article
Language:English
Published: United States 01.10.2012
Subjects:
Blalock-Taussig Procedure - adverse effects
Blalock-Taussig Procedure - mortality
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
Multivariate Analysis
North America
Norwood Procedures - adverse effects
Norwood Procedures - mortality
Odds Ratio
Postoperative Complications - etiology
Postoperative Complications - mortality
Prospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Ventricular Function
North America
ISSN:1097-685X, 1097-685X
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Summary: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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ISSN:1097-685X
1097-685X
DOI:10.1016/j.jtcvs.2012.05.020