Restrictive Atrial Septum Defect Becomes a Risk Factor for Norwood Palliation of Hypoplastic Left Heart Syndrome Only When It Is Combined with Mitral or Aortic Atresia. Thorac Cardiovasc Surg 2015 Aug;63(5):354-9
Date
05/03/2014Pubmed ID
24788706DOI
10.1055/s-0034-1374060Scopus ID
2-s2.0-84939265753 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
BACKGROUND: Restrictive atrial septal defect (ASD) is described as risk factor for Norwood procedure because of elevated pulmonary resistance. We hypothesized that it invariably could not cause pulmonary hypertension, unless it was combined with mitral valve or aortic valve atresia. We investigated how restrictive ASD influenced survival of patients with hypoplastic left heart syndrome (HLHS) who underwent Norwood operation.
PATIENTS AND METHODS: A total of 118 HLHS patients who underwent surgery between January 2005 and December 2012 were grouped into three groups. Group 1 included 31 patients with restrictive ASD combined with mitral or aortic atresia; Group 2 composed of 12 patients with restrictive ASD and mitral and aortic stenosis; Group 3 (n = 75) had no ASD restriction. Survival was determined for each group. Multivariate analysis was conducted to test risk factors for mortality.
RESULTS: Mean follow-up was 26.3 ± 24.1 months. Survival was 78.7% ± 4.2% at 30-month interval and onward after Norwood procedure for the whole cohort; it was 43.8% ± 10.0%, 91.7% ± 8.0%, and 77.3% ± 5.0% for Group 1, 2, and 3, respectively. The difference was significant between Group 1 and Group 2 and 3: p < 0.001. Survival was similar for Group 2 and Group 3: p = 0.45. Combination of restrictive ASD and mitral or aortic atresia was found to be the sole risk factor for early and late mortality (odds ratio: 3.5, 95% confidence interval: 1.8-7.1, p < 0.001).
CONCLUSION: Restrictive ASD only affects survival of HLHS patients following Norwood procedure if it is associated with mitral or aortic atresia.
Author List
Sata S, Sinzobahamvya N, Arenz C, Zartner P, Asfour B, Hraska VAuthor
Viktor Hraska MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Abnormalities, MultipleAortic Valve
Cohort Studies
Confidence Intervals
Female
Follow-Up Studies
Heart Defects, Congenital
Heart Septal Defects, Atrial
Humans
Hypoplastic Left Heart Syndrome
Infant
Kaplan-Meier Estimate
Male
Mitral Valve
Multivariate Analysis
Norwood Procedures
Retrospective Studies
Risk Assessment
Statistics, Nonparametric
Survival Analysis
Time Factors
Treatment Outcome
