Abstract 12621: Factors Affecting Fontan Length of Stay: Results From the Single Ventricle Reconstruction Trial
Background: In the Single Ventricle Reconstruction trial, subjects with hypoplastic left heart syndrome (HLHS) who received a right ventricle-to-pulmonary artery shunt (RVPAS) vs. modified Blalock-Taussig shunt (MBTS) had lower early postoperative mortality but more complications and worse RV ejection fraction at 14 mo. We explored the effect of shunt type and other patient and medical factors on postoperative length of stay (LOS) after the Fontan procedure.
Methods: Fontan postoperative course was ascertained from medical record review. Cox proportional hazards modeling was used to identify factors associated with LOS.
Results: Of 325 Fontan subjects, 323 were analyzed (1 death, 1 unknown discharge date). Of these, 285 (88%) had HLHS. Median age and weight at Fontan were 2.85 yr (IQR: 2.27, 3.37) and 12.7 kg (IQR: 11.4, 14.1), respectively. Fontan type was extracardiac in 178 (55%) and lateral tunnel in 145 (45%); 280 (87%) were fenestrated. Complications before discharge included pleural drainage >7 days in 58 (18%), arrhythmias in 50 (15%) and readmission within 30 days in 31 (10%). The RVPAS vs. MBTS subjects had similar LOS (median 11 d [IQR: 9, 18] vs. 10 d [IQR: 9, 13], P=.23). Independent risk factors for longer LOS were center (P<.01), LOS at Stage 2 (HR 1.02 for each additional day, P<.01), complications from birth to Fontan (HR 1.03 for each additional complication, P=.04). Use of circulatory arrest at Fontan (HR 0.61, P=.02) was associated with shorter LOS. When center was excluded from the multivariable model, pre-Fontan complications and use of circulatory arrest were no longer significant, and older age at Stage 2 (HR 1.08, P=.01) entered the model, predicting longer LOS. In 254 subjects with pre-Fontan Core Lab echocardiogram, ≥ moderate tricuspid regurgitation was independently associated with longer LOS both with center (HR 1.72, P<.01) and without center in the model (HR 1.49, P=.02). No variables from pre-Fontan catheterization (n=260) were associated with LOS.
Conclusion: In this multicenter prospective cohort, Norwood shunt type was not associated with Fontan LOS. Rather, global measures of earlier medical complexity including LOS at Stage 2 portend longer LOS after the Fontan procedure.
- Hypoplastic left heart
- Fontan physiology
- Congenital heart surgery
- Pediatric cardiac intensive care
Author Disclosures: C. Ravishankar: None. E. Gerstenberger: None. A.M. Atz: None. J. Affolter: None. T. Bradley: None. S. Menon: None. K. Schumacher: None. L.A. Sleeper: None. C. Dunbar-Masterson: None. J.W. Gaynor: None. B. Goldstein: None. H. Henderson: None. J. Jacobs: None. A.B. Lewis: None. V.L. Pemberton: None. C. Petit: None. N.A. Pike: None. C. Pizarro: None. I.A. Williams: None. J.W. Newburger: None.
- © 2014 by American Heart Association, Inc.