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| Impact of comprehensive perioperative and interstage monitoring on survival in high-risk infants after stage 1 palliation of univentricular heart disease | |
Nancy S. Ghanayem1, Kathleen A. Mussatto2, George M. Hoffman1, Michael E. Mitchell1, Michele A. Frommelt1, Joseph R. Cava1, James S. Tweddell1; 1Medical College of Wisconsin, Milwaukee, WI; 2Children's Hospital of Wisconsin, Milwaukee, WI
Methods: An IRB-approved prospective database of patients with univentricular cardiac defects undergoing stage 1 palliation was used to study outcomes since incorporation of a comprehensive goal-directed monitoring program. Patients were considered high-risk if ‰¤35 weeks gestation, birth weight <2.5kg, or extracardiac anomalies were present. Early (30 day) survival, survival to stage 2 palliation, 1 year survival, and survival to date were compared between high-risk and standard-risk groups utilizing chi-square and Kaplan-Meier survival analyses. Results: From 9/2000-9/2008 162 patients underwent stage 1 palliation. Patients were 24% (39/162) high-risk and 76% (123/162) standard-risk. Univentricular lesions other than hypoplastic left heart syndrome were more common in high-risk patients: 38% (15/39) versus 16% (20/123), p=0.006. Early survival was similar between groups: 97% (38/39) in high-risk versus 97% (119/123) in standard-risk. Survival to stage 2 palliation was 87.2% (34/39) in high-risk versus 93.5% (115/123) in low risk groups, p=0.2. High-risk patients discharged from ICU were more likely to require inpatient treatment until stage 2 palliation: 26% (9/34) versus 10% (12/118), p=0.003, although age at stage 2 palliation was not different (126±33 days versus 116±38 days, p=0.2). High-risk patients had lower 1 year survival (76% versus 93%, p=0.001) and survival to date (72% versus 92%, p=0.004). Conclusion: With an intensive monitoring strategy, identical high early survival was achieved in both patient risk strata. Prolonged interstage hospitalization for intensive non-invasive monitoring in high-risk patients until stage 2 palliation conferred similar survival to standard-risk patients monitored at home. Mortality beyond stage 2 palliation when level of monitoring is reduced is a relatively unique feature of high risk patients. Although mortality is reduced with enhanced monitoring, high resource utilization and late attrition of high-risk patients after stage 2 palliation suggests an ongoing need to evaluate our current palliative strategy for a subset of patients with univentricular heart disease.  Kaplan-Meier Curve by Risk Category Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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Copyright © 2012 American Association for Thoracic Surgery
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
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All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.