Interstage mortality after the Norwood procedure: Results of the multicenter Single Ventricle Reconstruction trial

Neighborhood Socioeconomic Status and Outcomes Following the Norwood Procedure: An Analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial Public Data Set

“…We chose to examine neighborhood SES over family SES because the SES score is a more comprehensive measure than single measures of parental education or income and has been validated across several populations. Moreover, studies have shown that neighborhood SES is associated with health outcomes in patients with CHD,6, 8, 14, 22, 23, 24 and others have suggested that neighborhood SES may predict health above and beyond individual SES 25. We also compared our findings to another US Census‐based indicator of neighborhood SES defined as neighborhood with at least 20% of individuals living below the federal poverty level.…”

“…Tweddell et al evaluated the role of neighborhood SES as one of the preoperative risk factors for 1‐year death and found that lower SES was associated with higher early mortality within the first year but not late phase mortality over 3 years 5. In contrast, Ghanayem et al used a census‐based neighborhood poverty level and found an inverted U‐shaped relationship between poverty level and interstage mortality 8. Like prior studies, we found that higher SES was associated with improved 1‐year transplant‐free survival after the Norwood procedure, an effect that was not explained by patient demographic, birth characteristics, or anatomy.…”

“…Therefore, risk factors for adverse outcome in the SV population have been the subject of many investigations. Among these, innate risk factors, such as low birth weight, anatomy, preterm birth, genetic abnormalities, and associated noncardiac congenital anomalies, are well‐established predictors for early mortality and transplantation 3, 4, 5, 6, 7, 8. Recently, societal factors such as poverty, medical insurance, and maternal education have emerged as predictors of adverse outcomes in children with complex congenital heart disease (CHD) and may explain some of the difference in survival between children with similar clinical characteristics 9.…”

“…Specifically, low socioeconomic status (SES) in children with SV physiology has been associated with higher early mortality6, 8 and lower quality of life10 after surgery, and other studies have found similar associations in the larger CHD population 11, 12, 13, 14, 15, 16. Nevertheless, existing studies examining SES have been limited by cross‐sectional or case–control study designs,14, 15 single center populations,7, 9, 10, 14, 15 or limited outcome assessment 6, 8. To date, there has been no in‐depth exploration of the relationship of SES with post‐Norwood outcomes in children with SV physiology.…”

Risk Factors for Death or Heart Transplant for Patients with Right Ventricular Dysfunction After the Norwood Procedure: A Secondary Analysis of the Single Ventricle Reconstruction Trial

“…Multiple secondary analyses have been published using this dataset. Examples include evaluation of the interstage mortality (Ghanayem et al 2012), risk factors for death or transplant in the intermediate term (Tweddell et al 2012) and 3 years term (Newburger et al 1993), as well as shunt type effect on the cardiac function, ventricular size (Frommelt et al 2012), and ventricular deformation (Hill et al 2015). However, the group of patients with ventricular dysfunction has not been evaluated separately.…”