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J Thorac Cardiovasc Surg. 2014 Oct;148(4):1540-7. doi: 10.1016/j.jtcvs.2014.02.038. Epub 2014 Feb 14.

Improving interstage survival after Norwood operation: outcomes from 10 years of home monitoring.

Author information

1
Section of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis. Electronic address: nrudd@chw.org.
2
Section of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis.
3
Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis.
4
Section of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Section of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis.
5
Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis.
6
Section of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis.

Abstract

OBJECTIVE:

Infants who undergo Norwood stage 1 palliation (S1P) continue with high-risk circulation until stage 2 palliation (S2P). Routine care during the interstage period is associated with 10% to 20% mortality. This report illustrates the sustained reduction of interstage mortality over 10 years associated with use of home monitoring.

METHODS:

Daily monitoring of oxygen saturation and weight was done for all patients discharged to home after S1P. Notification of the care team occurred for oxygen saturation<75% or >90%, weight gain<20 g over 3 days, weight loss>30 g, or intake<100 cc/kg/d. Breach of these criteria marked an interstage event. Interstage outcomes are reported. Patient characteristics and perioperative variables were compared between patients with and without interstage events.

RESULTS:

Over 10 years, 157 patients were discharged after S1P with home monitoring. Interstage survival was 98%. Breach of home criteria occurred in 59% (93 out of 157), with violation of oxygen saturation<75% the most common event. Patient characteristics, operative data, and early postoperative morbidity did not differ between patients with and without events.

CONCLUSIONS:

Home monitoring after S1P is associated with excellent interstage survival. Although a breach of monitoring criteria occurred in more than half of patients, our analysis failed to identify independent predictors of interstage events. Analysis of variables predicting mortality could not be assessed due to the low frequency of death in this cohort. Failure to identify specific variables for interstage events suggests that home monitoring, as part of an interstage surveillance program, should be applied to all S1P hospital survivors.

PMID:
24667026
DOI:
10.1016/j.jtcvs.2014.02.038
[Indexed for MEDLINE]
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