Faculty Collaboration Database

Cause, timing, and location of death in the Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg 2012 Oct;144(4):907-14

Date

08/21/2012

Pubmed ID

22901498

Pubmed Central ID

PMC3539407

DOI

10.1016/j.jtcvs.2012.04.028

Scopus ID

2-s2.0-84866391474 (requires institutional sign-in at Scopus site)   107 Citations

Abstract

OBJECTIVES: The Single Ventricle Reconstruction trial randomized 555 subjects with a single right ventricle undergoing the Norwood procedure at 15 North American centers to receive either a modified Blalock-Taussig shunt or right ventricle-to-pulmonary artery shunt. Results demonstrated a rate of death or cardiac transplantation by 12 months postrandomization of 36% for the modified Blalock-Taussig shunt and 26% for the right ventricle-to-pulmonary artery shunt, consistent with other publications. Despite this high mortality rate, little is known about the circumstances surrounding these deaths.

METHODS: There were 164 deaths within 12 months postrandomization. A committee adjudicated all deaths for cause and recorded the timing, location, and other factors for each event.

RESULTS: The most common cause of death was cardiovascular (42%), followed by unknown cause (24%) and multisystem organ failure (7%). The median age at death for subjects dying during the 12 months was 1.6 months (interquartile range, 0.6 to 3.7 months), with the highest number of deaths occurring during hospitalization related to the Norwood procedure. The most common location of death was at a Single Ventricle Reconstruction trial hospital (74%), followed by home (13%). There were 29 sudden, unexpected deaths (18%), although in retrospect, 12 were preceded by a prodrome.

CONCLUSIONS: In infants with a single right ventricle undergoing staged repair, the majority of deaths within 12 months of the procedure are due to cardiovascular causes, occur in a hospital, and within the first few months of life. Increased understanding of the circumstances surrounding the deaths of these single ventricle patients may reduce the high mortality rate.

Author List

Ohye RG, Schonbeck JV, Eghtesady P, Laussen PC, Pizarro C, Shrader P, Frank DU, Graham EM, Hill KD, Jacobs JP, Kanter KR, Kirsh JA, Lambert LM, Lewis AB, Ravishankar C, Tweddell JS, Williams IA, Pearson GD, Pediatric Heart Network Investigators

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

Blalock-Taussig Procedure
Cause of Death
Heart Defects, Congenital
Heart Ventricles
Hemodynamics
Hospital Mortality
Humans
Hypoplastic Left Heart Syndrome
Infant Mortality
Infant, Newborn
Kaplan-Meier Estimate
North America
Norwood Procedures
Postoperative Complications
Prospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Ventricular Function