(Screen 2 - 6:30 PM Friday) Short-Term Outcomes, Functional Status, and Risk Factors for Univentricular Patients Requiring Extracorporeal Life Support After Norwood Operation: A Single Center Retrospective Study
Assistant Professor of Pediatrics Emory University School of Medicine, Children's Healthcare of Atlanta Atlanta, Georgia, United States
Abstract:
Introduction: Patients requiring extracorporeal life support (ECLS) after a Norwood operation (NO) constitute a high-risk group. We retrospectively described short-term outcomes, functional status, and assessed risk factors for requiring ECLS after NO at a high-volume center.
Methods: Single-center retrospective study at an academic children’s hospital. All patients who required ECLS after NO between January/2010 – December/2020 were included. Analysis was performed using appropriate statistics with significance level set at p = 0.05.
Results: During the study period, 269 patients underwent a NO of which 65 (24%) required post-Norwood ECLS. Of the patients who required ECLS, 27 (42.5%) survived to hospital discharge. Mean functional status score (FSS) score at discharge increased from 6.0 on admission to 8.48 (p < 0.0001). The change was primarily in feeding and respiratory domains (p < 0.05). Of the survivors, 7 (26%) developed new morbidity, and 2 (7%) developed unfavorable outcomes.
In a multivariable logistic regression analysis, patients with moderate-severe univentricular dysfunction on the pre-Norwood transthoracic echocardiogram (TTE), m-BTT shunt, moderate-severe atrioventricular valve regurgitation (AVVR) on the transesophageal echocardiogram (TEE), delayed sternal closure, post-Norwood vasoactive inotropic score (VIS) score hours 24 – 48, and cardiac Cath had higher odds of ECLS requirement (p < 0.05).
Conclusions: Patients requiring ECLS post-Norwood procedure have a 43% survival. Of the survivors, 26% developed new morbidity, and 7% developed unfavorable outcomes. Patients with worse univentricular function in the pre-Norwood TTE and intraoperative TEE, delayed sternal closure, requirement of postoperative iNO, higher post-Norwood VIS scores, and requirement of post-Norwood cardiac Cath have higher odds of requiring ECLS support.
