Selective Use of Inpatient Interstage Management After Norwood Procedure

Tanem, Jena; Ghanayem, Nancy S.; Rudd, Nancy A.; Ollberding, Nicholas J.; Lavoie, Julie; Frommelt, Michele A.

doi:10.1016/j.athoracsur.2019.07.062

Cited by 14 publications

(6 citation statements)

References 25 publications

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“…Incidence of inter-stage mortality has been reported to be up to 12% in a multicenter trial [4]. Previous studies have identi ed several pre-and postoperative variables as risk factors for interstage mortality [13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Impact of home monitoring program on inter-stage mortality after the Norwood procedure

Staehler,

Schaeffer,

Wasner

et al. 2023

Preprint

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Background While early outcome after the Norwood operation for hypoplastic left heart syndrome has improved, inter-stage mortality until bidirectional cavopulmonary shunt (BCPS) remains a concern. Our aim was to institute a home monitoring program to (HMP) reduce inter-stage mortality. Methods Among 264 patients who survived Norwood procedure and were discharged before BCPS, 80 patients were included in the HMP and compared to the remaining 184 patients regarding inter-stage mortality. In patients with HMP, events during the inter-stage period were evaluated. Results Inter-stage mortality was 8% (n = 21) and was significantly lower in patients with HMP (2.5%, n = 2), compared to those without (10.3%, n = 19, p = 0.031). Patients with inter-stage mortality had significantly lower birth weight (p < 0.001) compared to those without. Lower birth weight (p < 0.001), extracorporeal membrane oxygenation support (p = 0.002), and lack of HMP (p = 0.048) were risk factors for inter-stage mortality. Most frequent event during home monitoring was low saturation (< 70%) in 14 patients (18%), followed by infection in 6 (7.5%), stagnant weight gain in 5 (6.3%), hypoxic shock in 3 (3.8%) and arrhythmia in 2 (2.5%). Unexpected readmission was needed in 24 patients (30%). In those patients, age (p = 0.001) and weight at BCPS (p = 0.007) were significantly lower compared to those without readmission, but the survival after BCPS was comparable between the groups. Conclusions Inter-stage HMP permits timely intervention and led to an important decrease in inter-stage mortality. One-third of the patients with home monitoring program needed readmission and demonstrated the need for earlier stage 2 palliation.

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Section: Discussionmentioning

confidence: 99%

Impact of home monitoring program on inter-stage mortality after the Norwood procedure

Staehler,

Schaeffer,

Wasner

et al. 2023

Preprint

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“…Some programs even advocate inpatient hospital care until the bidirectional Glenn for post-Norwood survivors deemed to be at high risk. [ 3 ] Home monitoring programs have evolved with time. The infant single-ventricle management and monitoring program proposes that patients be discharged from the hospital with a pulse oximeter and weighing scale.…”

Section: Discussionmentioning

confidence: 99%

“…These include continued inpatient hospital stay until Stage 2 palliation (the bidirectional superior cavopulmonary shunt) for high-risk patients, intensive home monitoring programs, and frequent outpatient hospital visits following initial hospital discharge, to comprehensively assess residual or acquired lesions that might require interstage interventions. [ 2 , 3 ] This study presents the results of a single institution in the interstage management of the Norwood procedure, focusing on the incidence, type, and outcome of catheter interventions in this period.…”

Section: Introductionmentioning

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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“…Many researchers used BMI for examining weight relative to height. However, others used 'weight-for-age' or 'weight-for-height' z-scores (WAZ and WHZ, respectively) [68][69][70]. Normative data for BMI also varied across studies with z-score or percentiles generated from Center for Disease Control (CDC), World Health Organization (WHO) or the United States National Center for Health Statistics reference populations.…”

Section: Heterogeneity In Definitions Of Relative Bodyweight and Bmi ...mentioning

confidence: 99%

Associations between Bodyweight and Clinical Outcome in Patients Post-Fontan Procedure: A Systematic Review

Payne¹,

Wilson²,

Haghighi³

et al. 2022

Congenital Heart Disease

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Background: Patients born with a single ventricle circulation commonly experience growth failure in early life, which is associated with adverse outcomes in infancy. However, associations between bodyweight or weight trajectory and clinical outcome post-Fontan procedure are yet to be determined. Methods: On the 1st of July 2021, a systematic review was performed in MEDLINE, EMBASE, the Cochrane Library, and Scopus of studies of patients with clinical outcome data post-Fontan procedure and association with bodyweight. Quality of studies was evaluated by Newcastle-Ottawa scale for cohort studies and Joanna Briggs Institute tool for cross-sectional studies. Results: Of 527 studies that underwent title and abstract screening, 15 were selected for final review. An increased risk of adverse post-Fontan outcomes was found for low weight patients, consistent with findings in infants. Whilst there is some evidence to suggest increased mortality in overweight adult patients, studies are conflicting as to whether overweight status is associated with increased heart failure. Increased BMI is associated with diminished exercise capacity and deceased physiological functioning. Negative weight trajectory is associated with adverse outcomes in the peri-Fontan period, whereas a positive weight trajectory is associated with increased Fontan failure in adulthood. Abnormal BMI (high or low) is associated with increased heart failure and poorer performance in quality-of-life scores. Conclusions: Bodyweight is a modifiable risk factor for poor clinical outcome in patients with a single ventricle circulation. Recognizing associations between bodyweight and Fontan pathophysiology may help to define patient-centered exercise and diet interventions that minimize patient morbidity and mortality.

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Selective Use of Inpatient Interstage Management After Norwood Procedure

Cited by 14 publications

References 25 publications

Impact of home monitoring program on inter-stage mortality after the Norwood procedure

Impact of home monitoring program on inter-stage mortality after the Norwood procedure

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

Associations between Bodyweight and Clinical Outcome in Patients Post-Fontan Procedure: A Systematic Review

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