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Influence of weight at the time of first palliation on survival in patients with a single ventricle

Published online by Cambridge University Press:  27 June 2017

Sushitha Surendran ,
T. K. Susheel Kumar ,
Ben Tansey ,
Jerry Allen ,
David Zurakowski ,
Umar Boston ,
Samir H. Shah  and
Christopher J. Knott-Craig
Sushitha Surendran*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
T. K. Susheel Kumar
Affiliation:
Department of Pediatric Cardiothoracic Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
Ben Tansey
Affiliation:
Department of Pediatric Cardiothoracic Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
Jerry Allen
Affiliation:
Department of Pediatric Cardiothoracic Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
David Zurakowski
Affiliation:
Departments of Anesthesia and Biostatistics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
Umar Boston
Affiliation:
Department of Pediatric Cardiothoracic Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
Samir H. Shah
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
Christopher J. Knott-Craig
Affiliation:
Department of Pediatric Cardiothoracic Surgery, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, Tennessee, United States of America
*
Correspondence to: S. Surendran, MD, Pediatric Cardiology Fellow, LeBonheur Children’s Hospital, 49 N. Dunlap St., Memphis, TN 38103, United States of America. Tel: 646 912 2679; Fax: 901 587 5970; E-mail: [email protected]
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Abstract

Background

Numerous advances in surgical techniques and understanding of single-ventricle physiology have resulted in improved survival. We sought to determine the influence of various demographic, perioperative, and patient-specific factors on the survival of single-ventricle patients following stage 1 palliation at our institution.

Methods

We conducted a retrospective study of all single-ventricle patients who had undergone staged palliation at our institution over an 8-year period. Data were collected from the Society of Thoracic Surgeons Congenital Heart Surgery database and from patient charts. Information on age, weight at stage 1 palliation, prematurity, genetic abnormalities, non-cardiac anomalies, ventricular dominance, and type of palliation was collected. Information on mortality and unplanned reinterventions was also collected.

Results

A total of 72 patients underwent stage 1 palliation over an 8-year period. There were 12 deaths before and one death after stage 2 palliation. There was no hospital mortality following Glenn or Fontan procedures. On univariate analysis, low weight at the time of stage 1 palliation and prematurity were found to be risk factors for mortality following stage 1 palliation. However, multivariable Cox regression analysis revealed weight at stage 1 palliation to be a strong predictor of mortality. The type of stage 1 palliation did not have any influence on the outcome. No difference in survival was noted following the Glenn procedure.

Conclusion

Low weight has a deleterious impact on survival following stage 1 palliation. This is mitigated by stage 2 palliation. The type of stage 1 palliation itself has no bearing on the outcome.

Keywords

Single ventriclelow weightstage 1 palliationmortality
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1778 - 1785
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Copyright
© Cambridge University Press 2017 

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