Single Ventricle Palliation in Low Weight Patients Is Associated With Worse Early And Midterm Outcomes

Results of Palliation With an Initial Modified Blalock-Taussig Shunt in Neonates With Single Ventricle Anomalies Associated With Restrictive Pulmonary Blood Flow

“…In a recent review from our institution examining the effect of low weight on palliation outcomes of SV patients, we identified that the incidence of prematurity, and chromosomal and extracardiac malformations in low weight neonates 2.5 kg or less was high. However, adjusted risk analysis continued to show that weight 2.5 kg or less was associated with increased hospital mortality and hazard of death for at least a year after initial palliative surgery, including mBTS [20]. Similarly, low weight was identified as an independent risk factor for mortality after mBTS in several recent single and multi-institutional studies [2,3,4,8,21].…”

“…Those worse outcomes in the SV spectrum of patients with PAIVS are attributed to the higher prevalence of ventricular to coronary arteries sinusoids and right ventricle-dependent coronary circulation with subsequent tenuous physiologic state and higher risk of ischemia and cardiac arrest prior to or after mBTS [16][17][18][19][20]. While some studies have reported improved outcomes in PAIVS patients, those improvements in general did not match the advances achieved in the multistage palliation of other SV anomalies and were not evident in a recent review from our, as well as other, institutions [16][17][18][19][20].…”

Results of Primary Repair Versus Shunt Palliation in Ductal Dependent Infants With Pulmonary Atresia and Ventricular Septal Defect

“…While the higher incidence of shunt occlusion in those patients is noticeable, a practice of leaving the ductus arteriosus without ligation in those patients would likely be counterproductive by increasing diastolic runoff and consequent steal from the coronary and systemic circulation with subsequent increased mortality, in addition to the competition of flow and the possibility of increasing the risk of shunt occlusion [6]. The morbidity and mortality risk after BTS is higher in low weight patients, usually due to small grafts used and subsequent risk of occlusion, in addition to the higher incidence of steal due to the relatively large sized shunt [5,6,8,9,11]. The incidence of prematurity and low weight at time of surgery in our patients with PAVSD was high (30%) and that likely contributed to the higher mortality risk in our current series.…”

“…Hospital death and interstage mortality are well-known complications after BTS [4][5][6][7][8][9]. While outcomes of BTS in patients with cardiac anomalies amenable to biventricular repair are better than those in patients with single ventricle anomalies, the mortality risk in patients with biventricular anomalies is not negligible [5][6][7][8][9]. During this study period, 174 neonates underwent BTS for biventricular anomalies at our institution and the mortality in those patients was 5 of 174 (2.9%) as compared with 14.9% in contemporaneous neonates who underwent BTS for single ventricle anomalies.…”

Impact of Patient Characteristics and Anatomy on Results of Norwood Operation for Hypoplastic Left Heart Syndrome

“…This higher mortality can be attributed to several issues related to small cardiac structures and tissue friability, postoperative management problems associated with prematurity, and shunt complications related to the difficulty in achieving a balance between small shunts with the risk of occlusion and the large shunts with the risk of overcirculation or systemic steal [16,17]. A recent review of 530 infants who underwent first-stage palliation including 284 Norwood operations showed that a weight of 2.5 Kg or less at the time of first-stage palliation was associated with increased hospital complications and stay, increased interstage mortality, decreased progression to the Glenn procedure, and increased hazard of death for at least a year after a first-stage operation [17]. This extended hazard of death might be related to the numerous associated issues in those patients such as prematurity and genetic syndromes.…”