Re-Examining Interstage Home Monitoring Following the Norwood Operation
Survival for children born with congenital heart disease has improved dramatically over the past 3 decades. Of the more than 35,000 children undergoing congenital heart surgery across the US each year, >95% now survive to hospital discharge1. Even for complex lesions such as hypoplastic left heart syndrome that were once uniformly fatal as recent as the early 1980's, early survival is now approximately 90% at experienced centers. However, as we have begun to learn more about the longer-term outcomes of these patients in recent years, it has become apparent that despite these gains in early survival, continued mortality over the mid- and long-term remains a challenge. For example, in the recent Pediatric Heart Network Single Ventricle Reconstruction Trial, which enrolled 549 patients undergoing the Norwood operation (randomized to a right-ventricle-to-pulmonary-artery shunt vs. modified Blalock-Taussig shunt), transplant-free survival in the overall cohort was 64% at a mean follow-up of 4.8 years2. One of the most high-risk periods is known to be the "interstage" period between discharge from the Norwood operation (Stage 1) and Stage 2 palliation (bidirectional Glenn, or hemi-Fontan operation) typically performed at 4-6 months of age. In the Single Ventricle Reconstruction Trial the interstage mortality rate was 12%3.
- Received June 23, 2015.
- Accepted June 24, 2015.