TY - JOUR
T1 - Factors affecting Fontan length of stay
T2 - Results from the Single Ventricle Reconstruction trial
AU - Pediatric Heart Network Investigators
AU - Ravishankar, Chitra
AU - Gerstenberger, Eric
AU - Sleeper, Lynn A.
AU - Atz, Andrew M.
AU - Affolter, Jeremy T.
AU - Bradley, Timothy J.
AU - Gaynor, J. William
AU - Goldstein, Bryan H.
AU - Henderson, Heather T.
AU - Jacobs, Jeffrey P.
AU - Lewis, Alan B.
AU - Dunbar-Masterson, Carolyn
AU - Menon, Shaji C.
AU - Pemberton, Victoria L.
AU - Petit, Christopher J.
AU - Pike, Nancy A.
AU - Pizarro, Christian
AU - Schumacher, Kurt R.
AU - Williams, Ismee A.
AU - Newburger, Jane W.
N1 - Publisher Copyright:
© 2016 The American Association for Thoracic Surgery.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - 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.
AB - 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.
KW - Fontan
KW - Single Ventricle Reconstruction trial
KW - hypoplastic left heart syndrome
UR - https://www.scopus.com/pages/publications/84958665115
U2 - 10.1016/j.jtcvs.2015.09.061
DO - 10.1016/j.jtcvs.2015.09.061
M3 - Article
C2 - 26519244
AN - SCOPUS:84958665115
SN - 0022-5223
VL - 151
SP - 669-675.e1
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 3
ER -