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Tytuł:
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Attrition between the superior cavopulmonary connection and the Fontan procedure in hypoplastic left heart syndrome.
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Autorzy:
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Lawrence KM; Department of Surgery, Weill Cornell New York Presbyterian, New York, NY.
Ittenbach RF; Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Hunt ML; Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
Kaplinski M; Division of Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, Calif.
Ravishankar C; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa.
Rychik J; Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa.
Steven JM; Division of Cardiac Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, Pa.
Fuller SM; Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa.
Nicolson SC; Division of Cardiac Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, Pa.
Gaynor JW; Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa.
Spray TL; Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa.
Mascio CE; Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa. Electronic address: .
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Źródło:
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The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2021 Aug; Vol. 162 (2), pp. 385-393. Date of Electronic Publication: 2020 Oct 22.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: St. Louis, MO : Mosby
Original Publication: St. Louis.
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MeSH Terms:
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Fontan Procedure*/adverse effects
Fontan Procedure*/mortality
Heart Bypass, Right*/adverse effects
Heart Bypass, Right*/mortality
Hypoplastic Left Heart Syndrome/*surgery
Age Factors ; Female ; Heart Transplantation ; Humans ; Hypoplastic Left Heart Syndrome/diagnostic imaging ; Hypoplastic Left Heart Syndrome/mortality ; Hypoplastic Left Heart Syndrome/physiopathology ; Infant ; Male ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome
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Contributed Indexing:
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Keywords: Fontan procedure; hypoplastic left heart syndrome; superior cavopulmonary connection
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Entry Date(s):
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Date Created: 20210214 Date Completed: 20210802 Latest Revision: 20210802
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Update Code:
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20240104
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DOI:
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10.1016/j.jtcvs.2020.10.053
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PMID:
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33581902
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Objective: We investigated the incidence and predictors of failure to undergo the Fontan in children with hypoplastic left heart syndrome who survived superior cavopulmonary connection.
Methods: The cohort consists of all patients with hypoplastic left heart syndrome who survived to hospital discharge after superior cavopulmonary connection between 1988 and 2017. The primary outcome was attrition, which was defined as death, nonsuitability for the Fontan, or cardiac transplantation before the Fontan. Subjects were excluded if they were awaiting the Fontan, were lost to follow-up, or underwent biventricular repair. The study period was divided into 4 eras based on changes in operative or medical management. Attrition was estimated with 95% confidence intervals, and predictors were identified using adjusted, logistic regression models.
Results: Of the 856 hospital survivors after superior cavopulmonary connection, 52 died, 7 were deemed unsuitable for Fontan, and 12 underwent or were awaiting heart transplant. Overall attrition was 8.3% (71/856). Attrition rate did not change significantly across eras. A best-fitting multiple logistic regression model was used, adjusting for superior cavopulmonary connection year and other influential covariates: right ventricle to pulmonary artery shunt at Norwood (P < .01), total support time at superior cavopulmonary connection (P < .01), atrioventricular valve reconstruction at superior cavopulmonary connection (P = .02), performance of other procedures at superior cavopulmonary connection (P = .01), and length of stay after superior cavopulmonary connection (P < .01).
Conclusions: In this study spanning more than 3 decades, 8.3% of children with hypoplastic left heart syndrome failed to undergo the Fontan after superior cavopulmonary connection. This attrition rate has not decreased over 30 years. Use of a right ventricle to pulmonary artery shunt at the Norwood procedure was associated with increased attrition.
(Copyright © 2020. Published by Elsevier Inc.)
Comment in: J Thorac Cardiovasc Surg. 2021 Aug;162(2):394-395. (PMID: 33339603)
Comment in: J Thorac Cardiovasc Surg. 2021 Aug;162(2):398-399. (PMID: 33341269)
Comment in: J Thorac Cardiovasc Surg. 2021 Aug;162(2):396-397. (PMID: 33487426)
