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Published in: Pediatric Cardiology 8/2013

01-12-2013 | Original Article

Effects of Race, Ethnicity, and Gender on Surgical Mortality in Hypoplastic Left Heart Syndrome

Authors: Peter N. Dean, Kimberly E. McHugh, Mark R. Conaway, Diane G. Hillman, Howard P. Gutgesell

Published in: Pediatric Cardiology | Issue 8/2013

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Abstract

Information is limited regarding the effect of race, ethnicity, and gender on the outcomes of the three palliative procedures for hypoplastic left heart syndrome (HLHS). This study examined the effects of race, ethnicity, gender, type of admission, and surgical volume on in-hospital mortality associated with palliative procedures for HLHS between 1998 and 2007 using data from the University HealthSystem Consortium. According to the data, 1,949 patients underwent stage 1 palliation (S1P) with a mortality rate of 29 %, 1,279 patients underwent stage 2 palliations (S2P) with a mortality rate of 5.4 %, and 1,084 patients underwent stage 3 palliation (S3P) with a mortality rate of 4.1 %. The risk factors for increased mortality with S1P were black and “other” race, smaller surgical volume, and early surgical era. The only risk factors for increased mortality with S2P were black race (11 % mortality; odds ratio [OR], 3.19; 95 % confidence interval [CI] 1.69–6.02) and Hispanic ethnicity (11 % mortality; OR 3.30; 95 % CI 1.64–6.64). For S2P, no racial differences were seen in the top five surgical volume institutions, but racial differences were seen in the non-top-five surgical volume institutions. Mortality with S1P was significantly higher for patients discharged after birth (37 vs 24 %; p = 0.004), and blacks were more likely to be discharged after birth (12 vs 5 % for all other races; p < 0.001). No racial differences with S3P were observed. The risk factors for increased mortality at S1P were black and “other” race, smaller surgical volume, and early surgical era. The risk factors for increased in-hospital mortality with S2P were black race and Hispanic ethnicity.
Literature
1.
go back to reference Anderson JB, Beekman RH III, Border WL, Kalkwarf HJ, Khoury PR, Uzark K, Eghtesady P, Marino BS (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 138:397–404 discussion e391CrossRefPubMed Anderson JB, Beekman RH III, Border WL, Kalkwarf HJ, Khoury PR, Uzark K, Eghtesady P, Marino BS (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 138:397–404 discussion e391CrossRefPubMed
2.
go back to reference Anderson JB, Beekman RH III, Eghtesady P, Kalkwarf HJ, Uzark K, Kehl JE, Marino BS (2010) Predictors of poor weight gain in infants with a single ventricle. J Pediatr 157:407–413 413 e401CrossRefPubMed Anderson JB, Beekman RH III, Eghtesady P, Kalkwarf HJ, Uzark K, Kehl JE, Marino BS (2010) Predictors of poor weight gain in infants with a single ventricle. J Pediatr 157:407–413 413 e401CrossRefPubMed
3.
go back to reference Artrip JH, Campbell DN, Ivy DD, Almodovar MC, Chan KC, Mitchell MB, Clarke DR, Lacour-Gayet F (2006) Birth weight and complexity are significant factors for the management of hypoplastic left heart syndrome. Ann Thorac Surg 82:1252–1257 discussion 1258–1259CrossRefPubMed Artrip JH, Campbell DN, Ivy DD, Almodovar MC, Chan KC, Mitchell MB, Clarke DR, Lacour-Gayet F (2006) Birth weight and complexity are significant factors for the management of hypoplastic left heart syndrome. Ann Thorac Surg 82:1252–1257 discussion 1258–1259CrossRefPubMed
4.
go back to reference Benavidez OJ, Gauvreau K, Jenkins KJ (2006) Racial and ethnic disparities in mortality following congenital heart surgery. Pediatr Cardiol 27:321–328CrossRefPubMed Benavidez OJ, Gauvreau K, Jenkins KJ (2006) Racial and ethnic disparities in mortality following congenital heart surgery. Pediatr Cardiol 27:321–328CrossRefPubMed
5.
go back to reference Berry JG, Cowley CG, Hoff CJ, Srivastava R (2006) In-hospital mortality for children with hypoplastic left heart syndrome after stage I surgical palliation: teaching versus nonteaching hospitals. Pediatrics 117:1307–1313CrossRefPubMed Berry JG, Cowley CG, Hoff CJ, Srivastava R (2006) In-hospital mortality for children with hypoplastic left heart syndrome after stage I surgical palliation: teaching versus nonteaching hospitals. Pediatrics 117:1307–1313CrossRefPubMed
6.
go back to reference Boneva RS, Botto LD, Moore CA, Yang Q, Correa A, Erickson JD (2001) Mortality associated with congenital heart defects in the United States: trends and racial disparities, 1979–1997. Circulation 103:2376–2381CrossRefPubMed Boneva RS, Botto LD, Moore CA, Yang Q, Correa A, Erickson JD (2001) Mortality associated with congenital heart defects in the United States: trends and racial disparities, 1979–1997. Circulation 103:2376–2381CrossRefPubMed
7.
go back to reference Brown KL, Ridout DA, Hoskote A, Verhulst L, Ricci M, Bull C (2006) Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates. Heart 92:1298–1302PubMedCentralCrossRefPubMed Brown KL, Ridout DA, Hoskote A, Verhulst L, Ricci M, Bull C (2006) Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates. Heart 92:1298–1302PubMedCentralCrossRefPubMed
8.
go back to reference Chan T, Pinto N, Bratton S (2012) Racial and insurance disparities in hospital mortality for children undergoing congenital heart surgery. Pediatr Cardiol 33(7):1026–1039CrossRefPubMed Chan T, Pinto N, Bratton S (2012) Racial and insurance disparities in hospital mortality for children undergoing congenital heart surgery. Pediatr Cardiol 33(7):1026–1039CrossRefPubMed
9.
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 106:1514–1522CrossRefPubMed Chang RK, Chen AY, Klitzner TS (2002) Female sex as a risk factor for in-hospital mortality among children undergoing cardiac surgery. Circulation 106:1514–1522CrossRefPubMed
10.
go back to reference Checchia PA, McCollegan J, Daher N, Kolovos N, Levy F, Markovitz B (2005) The effect of surgical case volume on outcome after the Norwood procedure. J Thorac Cardiovasc Surg 129:754–759CrossRefPubMed Checchia PA, McCollegan J, Daher N, Kolovos N, Levy F, Markovitz B (2005) The effect of surgical case volume on outcome after the Norwood procedure. J Thorac Cardiovasc Surg 129:754–759CrossRefPubMed
11.
go back to reference Cnota JF, Allen KR, Colan S, Covitz W, Graham EM, Hehir DA, Levine JC, Margossian R, McCrindle BW, Minich LL, Natarajan S, Richmond ME, Hsu DT, Pediatric Heart Network I (2012) Superior cavopulmonary anastomosis timing and outcomes in infants with single ventricle. J Thorac Cardiovasc Surg 145(5):1288–1296PubMedCentralCrossRefPubMed Cnota JF, Allen KR, Colan S, Covitz W, Graham EM, Hehir DA, Levine JC, Margossian R, McCrindle BW, Minich LL, Natarajan S, Richmond ME, Hsu DT, Pediatric Heart Network I (2012) Superior cavopulmonary anastomosis timing and outcomes in infants with single ventricle. J Thorac Cardiovasc Surg 145(5):1288–1296PubMedCentralCrossRefPubMed
12.
13.
go back to reference Dean PN, Hillman DG, McHugh KE, Gutgesell HP (2011) Inpatient costs and charges for surgical treatment of hypoplastic left heart syndrome. Pediatrics 128:e1181–e1186CrossRefPubMed Dean PN, Hillman DG, McHugh KE, Gutgesell HP (2011) Inpatient costs and charges for surgical treatment of hypoplastic left heart syndrome. Pediatrics 128:e1181–e1186CrossRefPubMed
14.
go back to reference Delmo Walter EM, Hubler M, Alexi-Meskishvili V, Miera O, Weng Y, Loforte A, Berger F, Hetzer R (2009) Staged surgical palliation in hypoplastic left heart syndrome and its variants. J Card Surg 24:383–391CrossRefPubMed Delmo Walter EM, Hubler M, Alexi-Meskishvili V, Miera O, Weng Y, Loforte A, Berger F, Hetzer R (2009) Staged surgical palliation in hypoplastic left heart syndrome and its variants. J Card Surg 24:383–391CrossRefPubMed
15.
go back to reference Dibardino DJ, Pasquali SK, Hirsch JC, Benjamin DK, Kleeman KC, Salazar JD, Jacobs ML, Mayer JE, Jacobs JP (2012) Effect of sex and race on outcome in patients undergoing congenital heart surgery: an analysis of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg 94:2054–2060CrossRefPubMed Dibardino DJ, Pasquali SK, Hirsch JC, Benjamin DK, Kleeman KC, Salazar JD, Jacobs ML, Mayer JE, Jacobs JP (2012) Effect of sex and race on outcome in patients undergoing congenital heart surgery: an analysis of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg 94:2054–2060CrossRefPubMed
16.
go back to reference d’Udekem Y, Xu MY, Galati JC, Lu S, Iyengar AJ, Konstantinov IE, Wheaton GR, Ramsay JM, Grigg LE, Millar J, Cheung MM, Brizard CP (2012) Predictors of survival after single-ventricle palliation: the impact of right ventricular dominance. J Am Coll Cardiol 59:1178–1185CrossRefPubMed d’Udekem Y, Xu MY, Galati JC, Lu S, Iyengar AJ, Konstantinov IE, Wheaton GR, Ramsay JM, Grigg LE, Millar J, Cheung MM, Brizard CP (2012) Predictors of survival after single-ventricle palliation: the impact of right ventricular dominance. J Am Coll Cardiol 59:1178–1185CrossRefPubMed
17.
go back to reference Feinstein JA, Benson DW, Dubin AM, Cohen MS, Maxey DM, Mahle WT, Pahl E, Villafane J, Bhatt AB, Peng LF, Johnson BA, Marsden AL, Daniels CJ, Rudd NA, Caldarone CA, Mussatto KA, Morales DL, Ivy DD, Gaynor JW, Tweddell JS, Deal BJ, Furck AK, Rosenthal GL, Ohye RG, Ghanayem NS, Cheatham JP, Tworetzky W, Martin GR (2012) Hypoplastic left heart syndrome: current considerations and expectations. J Am Coll Cardiol 59:S1–S42CrossRefPubMed Feinstein JA, Benson DW, Dubin AM, Cohen MS, Maxey DM, Mahle WT, Pahl E, Villafane J, Bhatt AB, Peng LF, Johnson BA, Marsden AL, Daniels CJ, Rudd NA, Caldarone CA, Mussatto KA, Morales DL, Ivy DD, Gaynor JW, Tweddell JS, Deal BJ, Furck AK, Rosenthal GL, Ohye RG, Ghanayem NS, Cheatham JP, Tworetzky W, Martin GR (2012) Hypoplastic left heart syndrome: current considerations and expectations. J Am Coll Cardiol 59:S1–S42CrossRefPubMed
18.
go back to reference Fixler DE, Nembhard WN, Salemi JL, Ethen MK, Canfield MA (2010) Mortality in first 5 years in infants with functional single ventricle born in Texas, 1996–2003. Circulation 121:644–650CrossRefPubMed Fixler DE, Nembhard WN, Salemi JL, Ethen MK, Canfield MA (2010) Mortality in first 5 years in infants with functional single ventricle born in Texas, 1996–2003. Circulation 121:644–650CrossRefPubMed
19.
go back to reference Fixler DE, Nembhard WN, Xu P, Ethen MK, Canfield MA (2012) Effect of acculturation and distance from cardiac center on congenital heart disease mortality. Pediatrics 129:1118–1124CrossRefPubMed Fixler DE, Nembhard WN, Xu P, Ethen MK, Canfield MA (2012) Effect of acculturation and distance from cardiac center on congenital heart disease mortality. Pediatrics 129:1118–1124CrossRefPubMed
20.
go back to reference Frank LH, Bradshaw E, Beekman R, Mahle WT, Martin GR (2013) Critical congenital heart disease screening using pulse oximetry. J Pediatr 162(3):445–453CrossRefPubMed Frank LH, Bradshaw E, Beekman R, Mahle WT, Martin GR (2013) Critical congenital heart disease screening using pulse oximetry. J Pediatr 162(3):445–453CrossRefPubMed
21.
go back to reference Gaynor JW, Mahle WT, Cohen MI, Ittenbach RF, DeCampli WM, Steven JM, Nicolson SC, Spray TL (2002) Risk factors for mortality after the Norwood procedure. Eur J Cardiothorac Surg 22:82–89CrossRefPubMed Gaynor JW, Mahle WT, Cohen MI, Ittenbach RF, DeCampli WM, Steven JM, Nicolson SC, Spray TL (2002) Risk factors for mortality after the Norwood procedure. Eur J Cardiothorac Surg 22:82–89CrossRefPubMed
22.
go back to reference Gilboa SM, Salemi JL, Nembhard WN, Fixler DE, Correa A (2010) Mortality resulting from congenital heart disease among children and adults in the United States, 1999–2006. Circulation 122:2254–2263CrossRefPubMed Gilboa SM, Salemi JL, Nembhard WN, Fixler DE, Correa A (2010) Mortality resulting from congenital heart disease among children and adults in the United States, 1999–2006. Circulation 122:2254–2263CrossRefPubMed
23.
go back to reference Gonzalez PC, Gauvreau K, Demone JA, Piercey GE, Jenkins KJ (2003) Regional racial and ethnic differences in mortality for congenital heart surgery in children may reflect unequal access to care. Pediatr Cardiol 24:103–108CrossRefPubMed Gonzalez PC, Gauvreau K, Demone JA, Piercey GE, Jenkins KJ (2003) Regional racial and ethnic differences in mortality for congenital heart surgery in children may reflect unequal access to care. Pediatr Cardiol 24:103–108CrossRefPubMed
24.
go back to reference Gordon BM, Rodriguez S, Lee M, Chang RK (2008) Decreasing number of deaths of infants with hypoplastic left heart syndrome. J Pediatr 153:354–358CrossRefPubMed Gordon BM, Rodriguez S, Lee M, Chang RK (2008) Decreasing number of deaths of infants with hypoplastic left heart syndrome. J Pediatr 153:354–358CrossRefPubMed
25.
go back to reference Hirsch JC, Gurney JG, Donohue JE, Gebremariam A, Bove EL, Ohye RG (2008) Hospital mortality for Norwood and arterial switch operations as a function of institutional volume. Pediatr Cardiol 29:713–717CrossRefPubMed Hirsch JC, Gurney JG, Donohue JE, Gebremariam A, Bove EL, Ohye RG (2008) Hospital mortality for Norwood and arterial switch operations as a function of institutional volume. Pediatr Cardiol 29:713–717CrossRefPubMed
26.
go back to reference Ingaramo OA, Khemani RG, Markovitz BP, Epstein D (2012) Effect of race on the timing of the Glenn and Fontan procedures for single-ventricle congenital heart disease. Pediatr Crit Care Med 13:174–177CrossRefPubMed Ingaramo OA, Khemani RG, Markovitz BP, Epstein D (2012) Effect of race on the timing of the Glenn and Fontan procedures for single-ventricle congenital heart disease. Pediatr Crit Care Med 13:174–177CrossRefPubMed
27.
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 1:77–88CrossRefPubMed Klitzner TS, Lee M, Rodriguez S, Chang RK (2006) Sex-related disparity in surgical mortality among pediatric patients. Congenit Heart Dis 1:77–88CrossRefPubMed
28.
go back to reference Mahle WT, Spray TL, Wernovsky G, Gaynor JW, Clark BJ III (2000) Survival after reconstructive surgery for hypoplastic left heart syndrome: a 15-year experience from a single institution. Circulation 102:III136–III141CrossRefPubMed Mahle WT, Spray TL, Wernovsky G, Gaynor JW, Clark BJ III (2000) Survival after reconstructive surgery for hypoplastic left heart syndrome: a 15-year experience from a single institution. Circulation 102:III136–III141CrossRefPubMed
29.
go back to reference Mahle WT, Newburger JW, Matherne GP, Smith FC, Hoke TR, Koppel R, Gidding SS, Beekman RH III, Grosse SD, American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young CoCN, Interdisciplinary Council on Quality of C, Outcomes R, American Academy of Pediatrics Section on C, Cardiac S, Committee on F, Newborn (2009) Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the AHA and AAP. Pediatrics 124:823–836CrossRefPubMed Mahle WT, Newburger JW, Matherne GP, Smith FC, Hoke TR, Koppel R, Gidding SS, Beekman RH III, Grosse SD, American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young CoCN, Interdisciplinary Council on Quality of C, Outcomes R, American Academy of Pediatrics Section on C, Cardiac S, Committee on F, Newborn (2009) Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the AHA and AAP. Pediatrics 124:823–836CrossRefPubMed
30.
go back to reference Mahle WT, Martin GR, Beekman RH III, Morrow WR, Section on Cardiology and Cardiac Surgery Executive Committee. (2012) Endorsement of health and human services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics 129:190–192CrossRefPubMed Mahle WT, Martin GR, Beekman RH III, Morrow WR, Section on Cardiology and Cardiac Surgery Executive Committee. (2012) Endorsement of health and human services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics 129:190–192CrossRefPubMed
31.
go back to reference McGuirk SP, Griselli M, Stumper OF, Rumball EM, Miller P, Dhillon R, de Giovanni JV, Wright JG, Barron DJ, Brawn WJ (2006) Staged surgical management of hypoplastic left heart syndrome: a single-institution 12-year experience. Heart 92:364–370PubMedCentralCrossRefPubMed McGuirk SP, Griselli M, Stumper OF, Rumball EM, Miller P, Dhillon R, de Giovanni JV, Wright JG, Barron DJ, Brawn WJ (2006) Staged surgical management of hypoplastic left heart syndrome: a single-institution 12-year experience. Heart 92:364–370PubMedCentralCrossRefPubMed
32.
go back to reference McHugh KE, Hillman DG, Gurka MJ, Gutgesell HP (2010) Three-stage palliation of hypoplastic left heart syndrome in the University healthsystem consortium. Congenit Heart Dis 5:8–15CrossRefPubMed McHugh KE, Hillman DG, Gurka MJ, Gutgesell HP (2010) Three-stage palliation of hypoplastic left heart syndrome in the University healthsystem consortium. Congenit Heart Dis 5:8–15CrossRefPubMed
33.
go back to reference Menon SC, McCandless RT, Mack GK, Lambert LM, McFadden M, Williams RV, Minich LL (2012) 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. Pediatr Cardiol 34(1):143–148CrossRefPubMed Menon SC, McCandless RT, Mack GK, Lambert LM, McFadden M, Williams RV, Minich LL (2012) 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. Pediatr Cardiol 34(1):143–148CrossRefPubMed
34.
go back to reference Milazzo AS Jr, Sanders SP, Armstrong BE, Li JS (2002) Racial and geographic disparities in timing of bidirectional Glenn and Fontan stages of single-ventricle palliation. J Natl Med Assoc 94:873–878PubMedCentralPubMed Milazzo AS Jr, Sanders SP, Armstrong BE, Li JS (2002) Racial and geographic disparities in timing of bidirectional Glenn and Fontan stages of single-ventricle palliation. J Natl Med Assoc 94:873–878PubMedCentralPubMed
35.
go back to reference Nembhard WN, Salemi JL, Ethen MK, Fixler DE, Dimaggio A, Canfield MA (2011) Racial/ethnic disparities in risk of early childhood mortality among children with congenital heart defects. Pediatrics 127:e1128–e1138CrossRefPubMed Nembhard WN, Salemi JL, Ethen MK, Fixler DE, Dimaggio A, Canfield MA (2011) Racial/ethnic disparities in risk of early childhood mortality among children with congenital heart defects. Pediatrics 127:e1128–e1138CrossRefPubMed
36.
go back to reference Oster ME, Strickland MJ, Mahle WT (2011) Racial and ethnic disparities in postoperative mortality following congenital heart surgery. J Pediatr 159:222–226CrossRefPubMed Oster ME, Strickland MJ, Mahle WT (2011) Racial and ethnic disparities in postoperative mortality following congenital heart surgery. J Pediatr 159:222–226CrossRefPubMed
37.
go back to reference Sano S, Huang SC, Kasahara S, Yoshizumi K, Kotani Y, Ishino K (2009) Risk factors for mortality after the Norwood procedure using right ventricle-to-pulmonary artery shunt. Ann Thorac Surg 87:178–185 discussion 185–176CrossRefPubMed Sano S, Huang SC, Kasahara S, Yoshizumi K, Kotani Y, Ishino K (2009) Risk factors for mortality after the Norwood procedure using right ventricle-to-pulmonary artery shunt. Ann Thorac Surg 87:178–185 discussion 185–176CrossRefPubMed
38.
go back to reference Seifert HA, Howard DL, Silber JH, Jobes DR (2007) Female gender increases the risk of death during hospitalization for pediatric cardiac surgery. J Thorac Cardiovasc Surg 133:668–675CrossRefPubMed Seifert HA, Howard DL, Silber JH, Jobes DR (2007) Female gender increases the risk of death during hospitalization for pediatric cardiac surgery. J Thorac Cardiovasc Surg 133:668–675CrossRefPubMed
39.
go back to reference Stasik CN, Gelehrter S, Goldberg CS, Bove EL, Devaney EJ, Ohye RG (2006) Current outcomes and risk factors for the Norwood procedure. J Thorac Cardiovasc Surg 131:412–417CrossRefPubMed Stasik CN, Gelehrter S, Goldberg CS, Bove EL, Devaney EJ, Ohye RG (2006) Current outcomes and risk factors for the Norwood procedure. J Thorac Cardiovasc Surg 131:412–417CrossRefPubMed
40.
go back to reference Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK (2012) Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. Lancet 379:2459–2464CrossRefPubMed Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK (2012) Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. Lancet 379:2459–2464CrossRefPubMed
41.
go back to reference Tweddell JS, Sleeper LA, Ohye RG, Williams IA, Mahony L, Pizarro C, Pemberton VL, Frommelt PC, Bradley SM, Cnota JF, Hirsch J, Kirshbom PM, Li JS, Pike N, Puchalski M, Ravishankar C, Jacobs JP, Laussen PC, McCrindle BW, Pediatric Heart Network I (2012) Intermediate-term mortality and cardiac transplantation in infants with single-ventricle lesions: risk factors and their interaction with shunt type. J Thorac Cardiovasc Surg 144:152–159PubMedCentralCrossRefPubMed Tweddell JS, Sleeper LA, Ohye RG, Williams IA, Mahony L, Pizarro C, Pemberton VL, Frommelt PC, Bradley SM, Cnota JF, Hirsch J, Kirshbom PM, Li JS, Pike N, Puchalski M, Ravishankar C, Jacobs JP, Laussen PC, McCrindle BW, Pediatric Heart Network I (2012) Intermediate-term mortality and cardiac transplantation in infants with single-ventricle lesions: risk factors and their interaction with shunt type. J Thorac Cardiovasc Surg 144:152–159PubMedCentralCrossRefPubMed
42.
go back to reference Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH (2001) Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 103:1269–1273CrossRefPubMed Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH (2001) Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 103:1269–1273CrossRefPubMed
Metadata
Title
Effects of Race, Ethnicity, and Gender on Surgical Mortality in Hypoplastic Left Heart Syndrome
Authors
Peter N. Dean
Kimberly E. McHugh
Mark R. Conaway
Diane G. Hillman
Howard P. Gutgesell
Publication date
01-12-2013
Publisher
Springer US
Published in
Pediatric Cardiology / Issue 8/2013
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-013-0723-3

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