Abstract 17619: Interstage Growth Trajectory is Associated With Interstage Survival in the Absence of Post-operative Complications Following the Norwood Procedure
Introduction: Low birth and procedure weight have been identified as risk factors for mortality after the Norwood operation. There are no strong data to show that growth during the interstage period is associated with interstage survival.
Hypothesis: We hypothesize that positive growth trajectory following the Norwood operation is associated with improved interstage transplant-free survival.
Methods: We conducted a retrospective cohort study using the National Pediatric Cardiology Quality Improvement Database. The exposure, growth trajectory, was the slope of the least-squares regression line of body mass index-for-age Z-scores over time. The outcome was interstage transplant-free survival. We constructed a multivariable logistic regression model to examine the association between interstage growth trajectory and interstage transplant-free survival.
Results: The study population included 1501 infants who were discharged alive from the Norwood operation between June 2008 and January 2015. The most common diagnosis was hypoplastic left heart syndrome with aortic and mitral atresia (34%). The most common operation was the Norwood procedure with a right ventricle to pulmonary artery shunt (55%). Interstage survival was 89%. Growth trajectory was positive in 945/1392 (68%) for whom sufficient data were available. The occurrence of at least one post-operative complication was identified as an effect measure modifier (p=0.02). When adjusted for sex, birth weight, presence of a secondary cardiac diagnosis, type of operation and post-operative arrhythmia, positive growth trajectory was significantly associated with interstage survival in the absence (OR=3.7, 95% CI 1.7, 8.0) but not in the presence (OR=1.1, 95% CI 0.7, 1.7) of post-operative complications.
Conclusions: Positive interstage growth trajectory is significantly associated with transplant-free interstage survival in the absence of post-operative complications.
Author Disclosures: C.F. Evans: None. D.S. Abraham: None. S. Kaushal: None. G.L. Rosenthal: None.
- © 2015 by American Heart Association, Inc.