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J Thorac Cardiovasc Surg. 2016 Mar;151(3):669-675.e1. doi: 10.1016/j.jtcvs.2015.09.061. Epub 2015 Sep 28.

Factors affecting Fontan length of stay: Results from the Single Ventricle Reconstruction trial.

Author information

1
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa. Electronic address: ravishankar@email.chop.edu.
2
New England Research Institute, Watertown, Mass.
3
Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
4
Department of Critical Care Medicine, The Children's Hospital of Wisconsin, Milwaukee, Wis.
5
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
6
Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa.
7
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
8
Department of Pediatrics, Duke Medical Center, Durham, NC.
9
Division of Cardiothoracic Surgery, Congenital Heart Institute of Florida, St Petersburg, Fla.
10
Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif.
11
Department of Cardiology, Boston Children's Hospital, Boston, Mass.
12
University of Utah, Department of Pediatrics, Salt Lake City, Utah.
13
National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
14
Department of Pediatrics, Sibley Heart Center, Atlanta, Ga.
15
Department of Nursing, University of California, Los Angeles, Los Angeles, Calif.
16
Division of Cardiothoracic Surgery, Alfred I. DuPont Hospital for Children, Wilmington, Del.
17
Department of Pediatrics, University of Michigan Health Center, Ann Arbor, Mich.
18
Department of Pediatrics, Columbia University Medical Center, New York, NY.

Abstract

BACKGROUND:

In the Single Ventricle Reconstruction trial, infants with hypoplastic left heart syndrome (HLHS) who received a right-ventricle-to-pulmonary-artery shunt (RVPAS) versus a modified Blalock-Taussig shunt (MBTS) had lower early postoperative mortality, but more complications at 14 months. We explored the effect of shunt type and other patient, medical, and surgical factors on postoperative length of stay (LOS) after the Fontan operation.

METHODS:

Fontan postoperative course was ascertained from medical record review. Cox proportional hazards modeling was used to identify factors associated with LOS.

RESULTS:

Of 327 subjects who underwent Fontan, 323 were analyzed (1 death, 1 biventricular repair, 2 with missing data). Median age and weight at Fontan were 2.8 years (interquartile range [IQR]: 2.3, 3.4) and 12.7 kg (IQR: 11.4, 14.1), respectively. Fontan type was extracardiac in 55% and lateral tunnel in 45%; 87% were fenestrated. The RVPAS and MBTS subjects had similar LOS (median 11 days [IQR: 9, 18] vs 10 days [IQR: 9, 13]; P = .23). Independent risk factors for longer LOS were treatment center (P < .01), LOS at stage II (hazard ratio [HR] 1.02 for each additional day; P < .01), and pre-Fontan complications (HR 1.03 for each additional complication; P = .04). Use of deep hypothermic circulatory arrest at Fontan (HR 0.64; P = .02) was independently associated with shorter LOS. When center was excluded from the model, pre-Fontan complications and use of circulatory arrest were no longer significant; instead, older age at stage II (HR 1.08 for each additional month; P = .01) predicted longer LOS. In 254 subjects who had a pre-Fontan echocardiogram, at least moderate tricuspid regurgitation was independently associated with longer LOS, both with center (HR 1.72; P < .01) and without center in the model (HR 1.49; P = .02).

CONCLUSIONS:

In this multicenter prospective cohort of subjects with HLHS, Norwood shunt type was not associated with Fontan LOS. Rather, global measures of earlier medical complexity indicate greater likelihood of longer LOS after the Fontan operation.

KEYWORDS:

Fontan; Single Ventricle Reconstruction trial; hypoplastic left heart syndrome

PMID:
26519244
PMCID:
PMC4761505
DOI:
10.1016/j.jtcvs.2015.09.061
[Indexed for MEDLINE]
Free PMC Article

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