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J Thorac Cardiovasc Surg. 2011 Oct;142(4):855-60. doi: 10.1016/j.jtcvs.2011.01.054. Epub 2011 Mar 12.

New approach to interstage care for palliated high-risk patients with congenital heart disease.

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  • 1Congenital Heart Institute at Miami Children's Hospital and Arnold Palmer Children's Hospital, Miami, FL 33155, USA.



Home surveillance monitoring might identify patients at risk for interstage death after stage 1 palliation for hypoplastic left heart syndrome. We sought to identify the effect that a high-risk program might have on interstage mortality and identification of residual/recurrent lesions after neonatal palliative operations.


Between January 2006 to January 2010, newborns after stage 1 palliation for hypoplastic left heart syndrome or shunt placement were invited to participate in our high-risk program. Patients enrolled in our high-risk program comprise the study group. Patients who had similar operations between January 2002 and December 2005 comprise the control group. Comparisons are made between the 2 groups with respect to interstage mortality and the frequency and timing of interstage admissions requiring medical, catheter, or surgical treatment.


Seventy-two patients met the criteria for our high-risk program. Fifty-nine (82%) of 72 patients were enrolled. Among 19 patients with hypoplastic left heart syndrome in our high-risk program, outpatient interstage mortality was zero. Outpatient interstage mortality for the 36 control subjects with hypoplastic left heart syndrome was 6%. Among 40 patients with shunts in the study group, there was 1 outpatient interstage death compared with 4 (6%) deaths in 68 subjects in the control group. Significant residual/recurrent lesions were identified with similar frequency between the 2 groups. However, after shunt operations, these lesions were detected and treated at significantly younger mean ages for patients followed in the high-risk program (P < .005).


Initiation of a high-risk program might decrease interstage mortality after high-risk neonatal palliative operations. Such an approach might contribute to earlier detection of significant residual/recurrent lesions amenable to therapy.

Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

[PubMed - indexed for MEDLINE]
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