Outcomes Associated With Unplanned Interstage Cardiac Interventions After Norwood Palliation

Castellanos, Daniel A.; Ocampo, Elena C.; Gooden, Angela M.; Wang, Yunfei; Qureshi, Athar M.; Heinle, Jeffrey S.; Mery, Carlos M.; Ghanayem, Nancy S.

doi:10.1016/j.athoracsur.2019.06.041

Cited by 9 publications

(1 citation statement)

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“…[ 5 ] A recent multicenter retrospective study demonstrated a 17% unplanned reintervention rate in a large cohort of patients. [ 6 ] A variety of pre- and perioperative factors during initial Norwood palliation were associated with an increased risk of an unplanned interstage catheter intervention. Although there was no difference in interstage mortality between the cohort undergoing an interventional procedure and those who did not (6% in both subgroups), a worrying finding was that patients who required an interstage intervention were unlikely to proceed to Stage 2 surgery (the bidirectional Glenn shunt), and more likely to receive undergo heart transplantation as the second procedure.…”

Section: Discussionmentioning

confidence: 99%

Indications for and outcomes of interstage catheter interventions following the Norwood procedure: A single-institution study

Sreeram¹,

Bouyaala²,

Bindermann³

et al. 2023

Ann Pediatr Card

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Aims: The aim of this study was to document the incidence, types, and outcome of interstage catheter interventions following the Norwood surgical palliation. Patients and Methods: A retrospective single-center study of all patients surviving the Norwood operation was performed. All data concerning interstage catheter interventions up to the completion of the superior cavopulmonary shunt were collected. Results: Catheter interventions were performed in 62 of 94 patients (66%; 38 males). These included interventions on the aortic arch ( n = 44), the branch pulmonary arteries (PAs) ( n = 17), and the Sano shunt ( n = 14). Multiple interventions and repeat interventions were common. The minimum aortic arch diameter (pre- versus posttreatment) increased from median 3.1 (2.3–3.3) mm to 5.1 (4.2–6.2) mm ( P < 0.001). The catheter pullback gradient decreased from 40 (36–46) mmHg to 9 (5–10) mmHg ( P < 0.001), and the echocardiographic gradient from 54 (45–64) mmHg to 12 (10–16) mmHg ( P < 0.001). The branch PA diameters increased from 2.4 (2.1–3.0) mmHg to 4.7 (4.2–5.1) mmHg ( P < 0.001). The minimum Sano shunt diameters increased from 2.0 (1.5–2.1) mm to 5.9 (5.8–6.0) mm ( P < 0.001); this was associated with an improvement in systemic saturation from 63% (60%–65%) to 80% (79–82%) ( P < 0.001). Unexpected interstage death at home occurred in two patients who had received no interventions. The remainder received a superior cavopulmonary shunt palliation. Conclusions: Catheter interventions were common. Systematic follow-up and a low threshold for reintervention are essential to the success of staged surgical palliation for this patient cohort.

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Section: Discussionmentioning

confidence: 99%