Abstract 16157: Risk Factors for Interstage Death After the Norwood Procedure
Objective: Interstage death (ISD) remains a significant risk for patients (pts) with hypoplastic left heart syndrome (HLHS). Risk factors for ISD remain largely unknown. The purpose of this study was to identify perioperative and social factors associated with ISD.
Methods: Medical record review was conducted for pts with HLHS and related defects, born from 1/2000 to 7/2009 and discharged alive following the Norwood procedure. Variables related to underlying anatomy (anatomic subtype, obstructed pulmonary veins, ascending aortic size), surgical course (shunt type, need for ECMO, necrotizing enterocolitis (NEC)), post-operative period (tricuspid valve regurgitation, right ventricular systolic function, arrhythmias, use of nasogastric (NG) tube at discharge), and social circumstance (maternal age, family structure) were reviewed. ISD was defined as death after discharge from the Norwood procedure and before stage II palliation. To test for statistical associations between ISD and potential risk factors, chi-square or Fisher exact tests were conducted for categorical variables. The Mann-Whitney test was performed for ordinal variables.
Results: The study sample included 278 pts (69.4% male). ISD occurred in 31 pts (11.2%). Variables related to anatomy were not statistically associated with increased risk of ISD. Although there was a higher proportion of ISD among pts who had aortopulmonary shunts vs right ventricle to pulmonary artery shunts, pts who required ECMO, developed NEC, had severe postoperative tricuspid regurgitation, and/or required NG feeding at discharge, the differences were not statistically significant. Children of mothers aged 15-19 had an increased risk of ISD (5/15, 33.3%) compared to older mothers (25/229, 10.9%; RR 3.05, 95% CI 1.36-6.83, p=0.025) (mother's age not available for 34 pts). Children in single caregiver homes had an increased risk of ISD (7/20, 35.0%) compared with those in two or more caregiver homes (24/257, 9.3%; RR 3.75, 95% CI 1.85-7.61, p=0.003).
Conclusions: Children of young mothers and children in single caregiver homes may be at increased risk of ISD. Although this study did not examine why such social conditions are associated with ISD, closer monitoring during the interstage period may be warranted.
- © 2010 by American Heart Association, Inc.