Risk Factors for Interstage Death After the Norwood Procedure

Abstract

Operative survival after the Norwood procedure has significantly improved during the past 10 years. However, there remains attrition among Norwood survivors before reaching planned second-stage palliation. The purpose of this study was to evaluate potential risk factors for interstage mortality among Norwood survivors. All patients undergoing the Norwood procedure at the Medical University of South Carolina from January 1996 through January 2001 were retrospectively reviewed. Patient and procedural variables were examined as potential risk factors for interstage mortality. Among 50 Norwood survivors, 8 (16%) died prior to second-stage palliation. The mean age at death was 102 +/- 72 days (median, 61; range, 35-208). By multivariate analysis, the presence of an arrhythmia in the postoperative period (p = 0.02) and decreased ventricular function at hospital discharge (p = 0.05) were identified as risk factors for interstage mortality. There remains a significant risk for interstage mortality among Norwood survivors. Patients with postoperative arrhythmias and/or decreased ventricular function at discharge are at increased risk for interstage death after Norwood procedure. More frequent follow-up and aggressive medical management of arrhythmia or decreased function may be warranted for these high-risk patients.

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

“…A few other studies have also examined interstage death, deaths that occur between being discharged to home post-Norwood procedure and admission for the stage II procedure, and reported an incidence of two to 20 % (Rudd et al 2014;Hehir et al 2008;Furck et al 2010;Ghanayem et al 2012;Simsic et al 2004). The Milwaukee group has reported an excellent interstage survival outcome of 98 % for interstage survival using their multidisciplinary home monitoring system (Rudd et al 2014) while other groups are still reporting significant interstage mortality (Furck et al 2010;Simsic et al 2004).…”

“…The Milwaukee group has reported an excellent interstage survival outcome of 98 % for interstage survival using their multidisciplinary home monitoring system (Rudd et al 2014) while other groups are still reporting significant interstage mortality (Furck et al 2010;Simsic et al 2004). A nested case-control study looked at 33 HLHS patients who experienced interstage deaths compared to 99 HLHS survivors (Hehir et al 2008).…”

Infant deaths in the UK community following successful cardiac surgery: building the evidence base for optimal surveillance, a mixed-methods study

“…The review included eight retrospective reviews of surgical cases, [23][24][25][26][27][28][29][30] four retrospective cohort studies, [31][32][33][34] two case-control studies 35,36 and one randomised controlled trial that was reported in two papers. 26,37 Only three studies 29,36,37 included a prospective element.…”

“…Although study designs differed, all studies were rated as good quality ( Table 1); studies that were assigned a lower rating failed to address some potential confounding factors. Ten reports were of patients with a functional single-ventricle (SV) diagnosis, 23,24,[26][27][28]30,33,[35][36][37] which was most often HLHS. Fourteen papers involved patients who underwent cardiac surgery during the first year of life and the remaining study 31 included cardiac patients operated up to the age of 18 years with results provided separately for each age group.…”

“…Five studies 23,26,30,33,35 involved children with SV diagnoses undergoing staged palliative surgery and reported 'interstage' mortality between first-and second-stage surgery that ranged from 8% to 16%, with follow-up ending at around 1 year after surgery in most studies. Two further studies focused on 'unexpected' interstage deaths, defined as acute events or sudden cardiovascular collapse, and reported 4-5% unexpected deaths in neonates discharged home between stages 1 and 2.…”