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Published in: Pediatric Cardiology 1/2013

01-01-2013 | Original Article

Clinical Outcomes and Resource Use for Infants With Hypoplastic Left Heart Syndrome During Bidirectional Glenn: Summary From the Joint Council for Congenital Heart Disease National Pediatric Cardiology Quality Improvement Collaborative Registry

Authors: Shaji C. Menon, Rachel T. McCandless, Gordon K. Mack, Linda M. Lambert, Molly McFadden, Richard V. Williams, L. LuAnn Minich

Published in: Pediatric Cardiology | Issue 1/2013

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Abstract

The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry captures information on interstage management of infants with hypoplastic left heart syndrome (HLHS). The purpose of this study was to identify interstage risk factors for increased resource use and adverse outcomes during bidirectional Glenn (BDG) hospitalization. All infants in the NPC-QIC registry (31 United States hospitals) undergoing BDG surgery were included (December 2009 to August 2010). Patient demographics, interstage variables, operative procedures, and complications were recorded. Days of hospitalization, ventilation, inotrope use, and complications were surrogates of resource use. Logistic regression analysis determined the associations between predictor variables and resource use. Of 162 infants, 105 (65 %) were males. At BDG, the median age was 155 days (range 78–128), mean weight-for-age z-score was −1.6 ± 1.1, mean length-for-age z-score was −1.5 ± 1.7, and mean preoperative oxygen saturation was 78 % ± 7 %. Caloric recommendations were met in 60 % of patients, and 85 % of patients participated in a home-surveillance program. Median days of intubation, inotrope use, and hospitalization were 1, 2, and 7, respectively. There were 4 post-BDG deaths and 55 complications. In multivariate analysis, lower weight-for-age z-score, female sex, and aortic atresia with mitral stenosis were associated with a higher risk of BDG complications. Meeting caloric recommendations before BDG was associated with fewer hospitalization days. Lower weight-for-age z-score was an independent and potentially modifiable risk factor for BDG complications. HLHS infants who met caloric recommendations before BDG had a lower duration of hospitalization at BDG. These data justify targeting nutrition in interstage strategies to improve outcomes and decrease costs for patients with HLHS.
Literature
1.
go back to reference Anderson JB, Beekman RH 3rd, Border WL, Kalkwarf HJ, Khoury PR, Uzark K et al (2009) Lower weight-for-age z-score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. J Thorac Cardiovasc Surg 138:397–404PubMedCrossRef Anderson JB, Beekman RH 3rd, Border WL, Kalkwarf HJ, Khoury PR, Uzark K et al (2009) Lower weight-for-age z-score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. J Thorac Cardiovasc Surg 138:397–404PubMedCrossRef
2.
go back to reference Andrews RE, Tulloh RM, Anderson DR, Lucas SB (2004) Acute myocardial infarction as a cause of death in palliated hypoplastic left heart syndrome. Heart 90:e17PubMedCrossRef Andrews RE, Tulloh RM, Anderson DR, Lucas SB (2004) Acute myocardial infarction as a cause of death in palliated hypoplastic left heart syndrome. Heart 90:e17PubMedCrossRef
3.
go back to reference Chang RK, Chen AY, Klitzner TS (2002) Female sex as a risk factor for in-hospital mortality among children undergoing cardiac surgery. Circulation 106:1514–1522PubMedCrossRef Chang RK, Chen AY, Klitzner TS (2002) Female sex as a risk factor for in-hospital mortality among children undergoing cardiac surgery. Circulation 106:1514–1522PubMedCrossRef
4.
go back to reference DeRose JJ Jr, Corda R, Dische MR, Eleazar J, Mosca RS (2002) Isolated left ventricular ischemia after the Norwood procedure. Ann Thorac Surg 73:657–659PubMedCrossRef DeRose JJ Jr, Corda R, Dische MR, Eleazar J, Mosca RS (2002) Isolated left ventricular ischemia after the Norwood procedure. Ann Thorac Surg 73:657–659PubMedCrossRef
5.
go back to reference Ghanayem NS, Hoffman GM, Mussatto KA, Cava JR, Frommelt PC, Rudd NA et al (2003) Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg 126:1367–1377PubMedCrossRef Ghanayem NS, Hoffman GM, Mussatto KA, Cava JR, Frommelt PC, Rudd NA et al (2003) Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg 126:1367–1377PubMedCrossRef
6.
go back to reference Ghanayem NS, Tweddell JS, Hoffman GM, Mussatto K, Jaquiss RD (2006) Optimal timing of the second stage of palliation for hypoplastic left heart syndrome facilitated through home monitoring, and the results of early cavopulmonary anastomosis. Cardiol Young 16(Suppl 1):61–66PubMedCrossRef Ghanayem NS, Tweddell JS, Hoffman GM, Mussatto K, Jaquiss RD (2006) Optimal timing of the second stage of palliation for hypoplastic left heart syndrome facilitated through home monitoring, and the results of early cavopulmonary anastomosis. Cardiol Young 16(Suppl 1):61–66PubMedCrossRef
7.
go back to reference Glatz JA, Fedderly RT, Ghanayem NS, Tweddell JS (2008) Impact of mitral stenosis and aortic atresia on survival in hypoplastic left heart syndrome. Ann Thorac Surg 85:2057–2062PubMedCrossRef Glatz JA, Fedderly RT, Ghanayem NS, Tweddell JS (2008) Impact of mitral stenosis and aortic atresia on survival in hypoplastic left heart syndrome. Ann Thorac Surg 85:2057–2062PubMedCrossRef
8.
go back to reference Hansen JH, Uebing A, Furck AK, Scheewe J, Jung O, Fischer G et al (2011) Risk factors for adverse outcome after superior cavopulmonary anastomosis for hypoplastic left heart syndrome. Eur J Cardiothorac Surg 40:e43–e49PubMedCrossRef Hansen JH, Uebing A, Furck AK, Scheewe J, Jung O, Fischer G et al (2011) Risk factors for adverse outcome after superior cavopulmonary anastomosis for hypoplastic left heart syndrome. Eur J Cardiothorac Surg 40:e43–e49PubMedCrossRef
9.
go back to reference Jaquiss RD, Ghanayem NS, Hoffman GM, Fedderly RT, Cava JR, Mussatto KA et al (2004) Early cavopulmonary anastomosis in very young infants after the Norwood procedure: impact on oxygenation, resource utilization, and mortality. J Thorac Cardiovasc Surg 127:982–989PubMedCrossRef Jaquiss RD, Ghanayem NS, Hoffman GM, Fedderly RT, Cava JR, Mussatto KA et al (2004) Early cavopulmonary anastomosis in very young infants after the Norwood procedure: impact on oxygenation, resource utilization, and mortality. J Thorac Cardiovasc Surg 127:982–989PubMedCrossRef
10.
go back to reference Klitzner TS, Lee M, Rodriguez S, Chang RK (2006) Sex-related disparity in surgical mortality among pediatric patients. Congenit Heart Dis 1:77–88PubMedCrossRef Klitzner TS, Lee M, Rodriguez S, Chang RK (2006) Sex-related disparity in surgical mortality among pediatric patients. Congenit Heart Dis 1:77–88PubMedCrossRef
11.
go back to reference Lamberti JJ, Spicer RL, Waldman JD, Grehl TM, Thomson D, George L et al (1990) The bidirectional cavopulmonary shunt. J Thorac Cardiovasc Surg 100:22–229PubMed Lamberti JJ, Spicer RL, Waldman JD, Grehl TM, Thomson D, George L et al (1990) The bidirectional cavopulmonary shunt. J Thorac Cardiovasc Surg 100:22–229PubMed
12.
go back to reference Ohye RG, Sleeper LA, Mahony L, Newburger JW, Pearson GD, Lu M et al (2010) Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med 362:1980–1992PubMedCrossRef Ohye RG, Sleeper LA, Mahony L, Newburger JW, Pearson GD, Lu M et al (2010) Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med 362:1980–1992PubMedCrossRef
13.
go back to reference Petrucci O, Khoury PR, Manning PB, Eghtesady P (2010) Outcomes of the bidirectional Glenn procedure in patients less than 3 months of age. J Thorac Cardiovasc Surg 139:562–568PubMedCrossRef Petrucci O, Khoury PR, Manning PB, Eghtesady P (2010) Outcomes of the bidirectional Glenn procedure in patients less than 3 months of age. J Thorac Cardiovasc Surg 139:562–568PubMedCrossRef
14.
go back to reference Schidlow DN, Anderson JB, Klitzner TS, Beekman RH 3rd, Jenkins KJ, Kugler JD et al (2011) Variation in interstage outpatient care after the Norwood procedure: a report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. Congenit Heart Dis 6:98–107PubMedCrossRef Schidlow DN, Anderson JB, Klitzner TS, Beekman RH 3rd, Jenkins KJ, Kugler JD et al (2011) Variation in interstage outpatient care after the Norwood procedure: a report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. Congenit Heart Dis 6:98–107PubMedCrossRef
15.
go back to reference Senagore AJ, Kilbride MJ, Luchtefeld MA, MacKeigan JM, Davis AT, Moore JD (1995) Superior nitrogen balance after laparoscopic-assisted colectomy. Ann Surg 221:171–175PubMedCrossRef Senagore AJ, Kilbride MJ, Luchtefeld MA, MacKeigan JM, Davis AT, Moore JD (1995) Superior nitrogen balance after laparoscopic-assisted colectomy. Ann Surg 221:171–175PubMedCrossRef
16.
go back to reference Tweddell JS, Hoffman GM, Mussatto KA, Fedderly RT, Berger S, Jaquiss RD et al (2002) Improved survival of patients undergoing palliation of hypoplastic left heart syndrome: lessons learned from 115 consecutive patients. Circulation 106:I82–I89PubMed Tweddell JS, Hoffman GM, Mussatto KA, Fedderly RT, Berger S, Jaquiss RD et al (2002) Improved survival of patients undergoing palliation of hypoplastic left heart syndrome: lessons learned from 115 consecutive patients. Circulation 106:I82–I89PubMed
Metadata
Title
Clinical Outcomes and Resource Use for Infants With Hypoplastic Left Heart Syndrome During Bidirectional Glenn: Summary From the Joint Council for Congenital Heart Disease National Pediatric Cardiology Quality Improvement Collaborative Registry
Authors
Shaji C. Menon
Rachel T. McCandless
Gordon K. Mack
Linda M. Lambert
Molly McFadden
Richard V. Williams
L. LuAnn Minich
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Pediatric Cardiology / Issue 1/2013
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-012-0403-8

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