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Perioperative monitoring in high-risk infants after stage 1 palliation of univentricular congenital heart disease. J Thorac Cardiovasc Surg 2010 Oct;140(4):857-63

Date

07/14/2010

Pubmed ID

20621312

DOI

10.1016/j.jtcvs.2010.05.002

Scopus ID

2-s2.0-77956885774   52 Citations

Abstract

OBJECTIVE: Survival of high-risk patients with univentricular heart disease after Norwood palliation is reduced. We hypothesized that early goal-directed monitoring with venous oximetry and near-infrared spectroscopy would offset their increased vulnerability and improve survival.

METHODS: A prospective database of patients undergoing stage 1 palliation was used to assess differences in outcomes across risk groups in the setting of a comprehensive, goal-directed monitoring program. High-risk criteria included gestational age 35 weeks or less, birth weight less than 2.5 kg, and additional cardiac or extracardiac anomalies. Outcomes included survival to defined end points and measures of postoperative support.

RESULTS: From September 2000 to September 2008, 162 patients underwent stage 1 palliation: 28% (45/162) high-risk and 72% (117/162) standard-risk patients. Lesions other than hypoplastic left heart syndrome were more common among high-risk patients (38%, 17/45, vs 15%, 18/117, P = .003). Operative survival was not statistically different(87%, 39/45, high risk vs 95%, 111/117, standard risk, P = .1). High-risk patients were more likely to receive inpatient treatment until stage 2 palliation (24%, 11/45, vs 10%, 12/117, P = .001) and had lower 1-year survival (78% vs 93%, P = .01) and survival to date (71% vs 92%, P = .001).

CONCLUSIONS: Intensive monitoring partially offset biologic vulnerability of high-risk patients, helping attain comparable early outcomes. Vulnerability persisted throughout the interstage period, however, and increased mortality beyond cavopulmonary shunt was seen only among high-risk patients. Although enhanced monitoring reduced early mortality, high resource use and attrition after stage 2 palliation suggest an ongoing need to evaluate our current palliative strategy for this subset of patients.

Author List

Ghanayem NS, Hoffman GM, Mussatto KA, Frommelt MA, Cava JR, Mitchell ME, Tweddell JS

Authors

Joseph R. Cava MD, PhD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Michele Ann Frommelt MD Professor in the Pediatrics department at Medical College of Wisconsin
George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Michael Edward Mitchell MD Professor in the Surgery department at Medical College of Wisconsin
Kathleen Mussatto in the CTSI department at Medical College of Wisconsin - CTSI




MESH terms used to index this publication - Major topics in bold

Biomarkers
Chi-Square Distribution
Databases as Topic
Female
Heart Bypass, Right
Heart Defects, Congenital
Humans
Infant
Infant, Newborn
Kaplan-Meier Estimate
Male
Monitoring, Physiologic
Oximetry
Oxygen
Palliative Care
Perioperative Care
Prospective Studies
Regression Analysis
Risk Assessment
Risk Factors
Spectroscopy, Near-Infrared
Time Factors
Treatment Outcome
Wisconsin
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