Congenital heart disease
Risk factors for hospital morbidity and mortality after the Norwood procedure: A report from the Pediatric Heart Network Single Ventricle Reconstruction trial

https://doi.org/10.1016/j.jtcvs.2012.05.019Get rights and content
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Objectives

We sought to identify risk factors for mortality and morbidity during the Norwood hospitalization in newborn infants with hypoplastic left heart syndrome and other single right ventricle anomalies enrolled in the Single Ventricle Reconstruction trial.

Methods

Potential predictors for outcome included patient- and procedure-related variables and center volume and surgeon volume. Outcome variables occurring during the Norwood procedure and before hospital discharge or stage II procedure included mortality, end-organ complications, length of ventilation, and hospital length of stay. Univariate and multivariable Cox regression analyses were performed with bootstrapping to estimate reliability for mortality.

Results

Analysis included 549 subjects prospectively enrolled from 15 centers; 30-day and hospital mortality were 11.5% (63/549) and 16.0% (88/549), respectively. Independent risk factors for both 30-day and hospital mortality included lower birth weight, genetic abnormality, extracorporeal membrane oxygenation (ECMO) and open sternum on the day of the Norwood procedure. In addition, longer duration of deep hypothermic circulatory arrest was a risk factor for 30-day mortality. Shunt type at the end of the Norwood procedure was not a significant risk factor for 30-day or hospital mortality. Independent risk factors for postoperative renal failure (n = 46), sepsis (n = 93), increased length of ventilation, and hospital length of stay among survivors included genetic abnormality, lower center/surgeon volume, open sternum, and post-Norwood operations.

Conclusions

Innate patient factors, ECMO, open sternum, and lower center/surgeon volume are important risk factors for postoperative mortality and/or morbidity during the Norwood hospitalization.

CTSNet classification

20

Abbreviations and Acronyms

CPB
cardiopulmonary bypass
CPR
cardiopulmonary resuscitation
DHCA
deep hypothermic circulatory arrest
ECMO
extracorporeal membrane oxygenation
E-CPR
ECMO required to restore circulation during CPR
HLHS
hypoplastic left heart syndrome
MBTS
modified Blalock-Taussig shunt
RCP
regional cerebral perfusion
RVPAS
right ventricular–pulmonary artery shunt
SVR
Single Ventricle Reconstruction

Cited by (0)

Supported by grants from the National Heart, Lung, and Blood Institute (HL068269, HL068270, HL068279, HL068281, HL068285, HL068292, HL068290, HL068288, HL085057). This work is solely the responsibility of the authors and does not necessarily represent the official views of the NHLBI.

Disclosures: Authors have nothing to disclose with regard to commercial support.

Dr Tabbutt's current affiliation is University of California San Francisco Benioff Children's Hospital, San Francisco, Calif; Dr Cooper's current affiliation is Cincinnati Children's Medical Center, Cincinnati, Ohio; and Dr Simsic's current affiliation is Nationwide Children's Hospital, Columbus, Ohio.

Clinical Trial Registration No. NCT00115934.