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J Thorac Cardiovasc Surg. 2014 Jun;147(6):1791-8, 1798.e1-4. doi: 10.1016/j.jtcvs.2013.07.063. Epub 2013 Sep 24.

Risk factors for prolonged length of stay after the stage 2 procedure in the single-ventricle reconstruction trial.

Author information

  • 1Divisions of Cardiac Critical Care Medicine and Cardiology, Departments of Critical Care Medicine and Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: steven.schwartz@sickkids.ca.
  • 2New England Research Institutes, Watertown, Mass.
  • 3Division of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Mich.
  • 4Division of Cardiology, Department of Pediatrics, Duke University, Durham, NC.
  • 5Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
  • 6Division of Critical Care Medicine, Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pa.
  • 7Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, New York, NY.
  • 8Division of Pediatric Cardiology, Department of Pediatrics & Communicable Diseases, University of Michigan Medical School, Ann Arbor, Mich.
  • 9Division of Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, Calif.
  • 10Department of Cardiac Surgery, Children's Hospital Boston, Boston, Mass.
  • 11Division of Cardiovascular Surgery, Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
  • 12Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Alfred I. duPont Hospital for Children, Wilmington, Del.
  • 13Division of Cardiovascular Surgery, All Children's Hospital, Tampa, Fla.
  • 14Division of Pediatric Cardiology, Department of Pediatrics, Primary Children's Medical Center, Salt Lake City, Utah.
  • 15Department of Cardiology, Children's Hospital Boston, Boston, Mass.
  • 16Heart Development and Structural Diseases Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.
  • 17Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, Ga.
  • 18Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wis.

Abstract

BACKGROUND:

The single-ventricle reconstruction trial randomized patients with single right ventricle lesions to a modified Blalock-Taussig or right ventricle-to-pulmonary artery shunt at the Norwood. This analysis describes outcomes at the stage 2 procedure and factors associated with a longer hospital length of stay (LOS).

METHODS:

We examined the association of shunt type with stage 2 hospital outcomes. Cox regression and bootstrapping were used to evaluate risk factors for longer LOS. We also examined characteristics associated with in-hospital death.

RESULTS:

There were 393 subjects in the analytic cohort. Median stage 2 procedure hospital LOS (8 days; interquartile range [IQR], 6-14 days), hospital mortality (4.3%), transplantation (0.8%), median ventilator time (2 days; IQR, 1-3 days), median intensive care unit LOS (4 days; IQR, 3-7 days), number of additional cardiac procedures or complications, and serious adverse events did not differ by shunt type. Longer LOS was associated (R(2) = 0.26) with center, longer post-Norwood LOS (hazard ratio [HR], 1.93 per log day; P < .001), nonelective timing of the stage 2 procedure (HR, 1.78; P < .001), and pulmonary artery (PA) stenosis (HR, 1.56; P < .001). By univariate analysis, nonelective stage 2 (65% vs 32%; P = .009), moderate or greater atrioventricular valve (AVV) regurgitation (75% vs 24%; P < .001), and AVV repair (53% vs 9%; P < .001) were among the risk factors associated with in-hospital death.

CONCLUSIONS:

Norwood LOS, PA stenoses, and nonelective stage 2 procedure, but not shunt type, are independently associated with longer LOS. Nonelective stage 2 procedure, moderate or greater AVV regurgitation, and need for AVV repair are among the risk factors for death.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00115934.

Copyright © 2014 The American Association for Thoracic Surgery. All rights reserved.

PMID:
24075564
[PubMed - indexed for MEDLINE]
PMCID:
PMC3964142
Free PMC Article

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