Abstract 14458: Improving Interstage Survival After Norwood Operation: Outcomes Following 10 Years of Home Monitoring
Background: Patients with hypoplastic left heart syndrome (HLHS) and variants who undergo stage 1 palliation (S1P), Norwood operation, continue with high-risk circulation until stage 2 palliation (S2P). Routine care during the interstage period (S1P discharge to S2P) is associated with up to 20% mortality. To improve survival to S2P, an interstage surveillance program (ISP) was implemented for early detection of physiological variances that may be indicative of impending crisis.
Methods: The ISP includes daily home monitoring of oxygen saturation (SpO2) and weight with notification of cardiac care team if SpO2 <75% or >90%, if weight gain <20 grams over 3 days, if weight loss >30 grams, or intake <100cc/kg/day. Additional surveillance includes multidisciplinary outpatient clinic visits and weekly phone calls to parents. Interstage events and characteristics at S2P are reported.
Results: From October 2000 to October 2010, all 153 pts discharged after S1P participated in the ISP. Modified Blalock-Taussig shunt (MBTS) was used in 96 pts and a right ventricle to pulmonary artery shunt (RVPAS) in 57 pts. Duration of home monitoring ranged from 4-165 days. Interstage survival was 98% (150/153). Two pts died suddenly without symptoms and 1 pt died after 12 hours of poor oral intake and SpO2>90%. Home monitored events occurred 154 times in 62% (95/153) pts; similar rates of events occurred in pts with MBTS vs. RVPAS, 60% vs. 65% (p=.5). Of the 95 pts with events, 47(50%) experienced breach of SpO2 thresholds, 23 (24%) inappropriate weight change and 25 (26%) concurrent breach of both criteria. Weight at S2P was 5.5 +/- .8 kg in pts with events vs. 5.8 +/- .8 kg in pts without events (p=.05). Age at S2P for event pts was 112 +/- 29 days vs. 133 +/- 39 days (p=.008) for pts without events. Weight gain for ISP pts averaged 26gm/day with 100% S2P operative survival.
Conclusion: Home monitoring of SpO2 and weight change is effective in identifying at-risk physiologic changes in pts following S1P and is associated with excellent interstage survival. Focused attention on nutrition results in normal somatic growth during the interstage period. Utilization of an ISP improves outcomes and should be standard practice between S1P and S2P in patients with HLHS.
- © 2011 by American Heart Association, Inc.