Abstract 12185: Interstage Mortality after the Norwood Procedure: Results of the Multi-Center Single Ventricle Reconstruction Trial
Background: For infants with HLHS interstage mortality (ISM) is reported at 2-20%. The Single Ventricle Reconstruction (SVR) Trial randomized 555 pts with HLHS to either a modified Blalock Taussig Shunt (MBTS) or a right ventricle to pulmonary artery shunt (RVPAS). We explored associations between ISM and shunt type as well as demographic, anatomic and peri-operative factors.
Methods: There are 426 SVR trial participants who survived to hospital discharge following Norwood operation and were included. ISM was defined as death or transplant between Norwood discharge and stage II operation. Univariate analysis and multivariable logistic regression were performed adjusting for surgical site with bootstrapping for reliability.
Results: Overall ISM was 50/426 (12%); 13/225 (6%) for RVPAS and 37/201 (18%) for MBTS (OR for MBTS 3.4, p<.001). Pre-Norwood and perioperative variables associated with ISM in univariate analysis included gestational age <37 wks (p=.01), pre-operative > moderate atrioventricular valve regurgitation (AVVR) (p=.004), ascending aorta<3mm (p=.008), longer Norwood hospitalization (p=.03), greater number of post-Norwood complications (p<.001), inability to take oral feeds prior to Norwood discharge (p<.001) and census block poverty level (p=.006). Lower right ventricular (RV) EF (p=.012), and greater indexed RV systolic volume (p=.03) at post-Norwood echo were associated with ISM. Using interaction terms, ISM was not different between shunt types when moderate to severe post-operative AVVR was present (p=.009). Using multivariable logistic modeling ISM was independently associated with gestational age<37 wks (OR 3.9, p=.008), Hispanic ethnicity (OR 2.6, p=.04), aortic atresia/mitral atresia (OR 2.3, p=.03), increased number of post Norwood complications (OR 1.2, p=.006), census block poverty level ( p=0.003), and MBTS in patients with mild or no AVVR (OR 9.7, p<.001).
Conclusions: ISM remains high at 12%. ISM is increased with MBTS compared to RVPAS only if no more than mild AVVR. Preterm delivery, anatomic, and socioeconomic factors also are important. Targeting high-risk socioeconomic groups, and avoiding pre-term delivery may reduce ISM.
- © 2011 by American Heart Association, Inc.