Format

Send to

Choose Destination
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

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

PMID:
24075564
PMCID:
PMC3964142
DOI:
10.1016/j.jtcvs.2013.07.063
[Indexed for MEDLINE]
Free PMC Article

Publication types, MeSH terms, Secondary source ID, Grant support

Publication types

MeSH terms

Secondary source ID

Grant support

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center