Assistant Professor of Pediatrics Emory University School of Medicine, Children's Healthcare of Atlanta Atlanta, Georgia, United States
Abstract:
Background: Recent published data has suggested that there has been a plateau in the survival after Norwood with no decrease in mortality over the last 20 years. As there is continued attrition after stages 2 and 3, we wanted to analyze if short term outcomes and survival have changed after stage 2 pallitation. We also wanted to assess if there has been a change in the patient cohort undergoing stage 2 palliation over the last decade.
Methods: Retrospective single-center study at an academic quaternary children’s hospital. All patients who underwent stage 2 palliation between January 2008 – December 2020 were included. We aimed to examine short term outcomes of patients who underwent staged palliation stratified by surgical era (pre-2014, and 2014-2022). Analysis was performed using appropriate statistics with significance level set at p = 0.05.
Results: During the study period there were 553 patients who reached stage 2 palliation who were included in this study, of which 307 patients (55.5%) were in the 2014-2020 era, and 246 (44.5%) in the pre-2014 era. Median CPB time 78.5 min, median hospital length of stay was 7 days, and operative mortality was 3.4% (19/556) of the entire cohort. When comparing short term outcomes of patients in the 2014-2020 era to the pre-2014 era, patients in the pre-2014 era were smaller (median weight 6.0 vs 6.2 kg), had higher median hemoglobin (HGB) at the pre-Stage 2 cardiac Cath (13.3 vs 12.8), had lower median arterial saturation (75% vs 80%), had higher median indexed pulmonary vascular resistance (PVRi) (1.5 vs 1.3 WUi), had shorter median CPB times (62 vs 89 minutes), and shorter median hospital length of stay (LOS) (6 vs 8 days) (p < 0.05). There was no difference in both eras in respect to antegrade pulmonary blood flow, right and left pulmonary artery sizes in the pre-stages 2 and 3 cardiac Cath, age at time of surgery, and operative mortality (2.4% vs 4.2%). There were more patients with genetic syndromes operated on in the 2014-2020 era when compared to the pre-2014 era. Post stage-2 mortality was similar (9.3% vs 7.8%) in both eras.
Conclusions: Although the pre-Stage 2 cardiac Cath values are slightly different between both eras they are not of clinical significance. In the more recent era, patients with genetic syndromes are operated on more with no difference in short-term outcomes. We conclude that short term outcomes are similar across the surgical era.
