Alaa Aljiffry , Ashley Harriott , Shayli Patel , Amy Scheel , Alan Amedi , Sean Evans , Yijin Xiang , Amanda Harding , Subhadra Shashidharan , Asaad G. Beshish
{"title":"结果、死亡率风险因素和诺伍德后的功能状态：单中心研究","authors":"Alaa Aljiffry , Ashley Harriott , Shayli Patel , Amy Scheel , Alan Amedi , Sean Evans , Yijin Xiang , Amanda Harding , Subhadra Shashidharan , Asaad G. Beshish","doi":"10.1016/j.ijcchd.2024.100533","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>The Norwood operation (NO) for infants with univentricular physiology has high interstage mortality. This study evaluated outcomes and risk factors for mortality following NO.</p></div><div><h3>Methods</h3><p>Retrospective single-center study of patients undergoing NO from 2010 to 2020. Analysis used appropriate statistics.</p></div><div><h3>Results</h3><p>Of 269 patients undergoing NO, 213 (79.2 %) survived to discharge. Non-survivors had longer bypass times, delayed sternal closure, required nitric oxide, higher vasoactive scores, required post-operative catheterization, Extracorporeal Life Support (ECLS), and longer ventilation (p < 0.05). Logistic regression showed moderate-severe atrioventricular valve regurgitation on intraoperative TEE (OR 2.6), requiring nitric oxide (OR 2.63), delayed sternal closure (OR 2.94), post-operative catheterization (OR 10.48), and ECLS (OR 14.54) increased mortality odds (p < 0.05). Multivariable analysis confirmed catheterization (aOR 10.48) and ECLS (aOR 14.54) as significant predictors. Of survivors, 26 (12.3 %) developed new morbidity, 9 (4.2 %) had unfavorable outcomes. Functional status improved from 6.0 to 8.04, mainly in feeding and respiratory domains (p < 0.0001).</p></div><div><h3>Conclusions</h3><p>Norwood survival was 79.2 %. Requiring post-operative catheterization and ECLS significantly increased mortality risk. Multicenter evaluation of these modifiable risk factors is needed to improve outcomes in this high-risk population.</p></div>","PeriodicalId":73429,"journal":{"name":"International journal of cardiology. Congenital heart disease","volume":"17 ","pages":"Article 100533"},"PeriodicalIF":0.8000,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666668524000429/pdfft?md5=e08ecc7ded54dee64f3ee71a698dc086&pid=1-s2.0-S2666668524000429-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Outcomes, mortality risk factors, and functional status post-Norwood: A single-center study\",\"authors\":\"Alaa Aljiffry , Ashley Harriott , Shayli Patel , Amy Scheel , Alan Amedi , Sean Evans , Yijin Xiang , Amanda Harding , Subhadra Shashidharan , Asaad G. Beshish\",\"doi\":\"10.1016/j.ijcchd.2024.100533\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The Norwood operation (NO) for infants with univentricular physiology has high interstage mortality. This study evaluated outcomes and risk factors for mortality following NO.</p></div><div><h3>Methods</h3><p>Retrospective single-center study of patients undergoing NO from 2010 to 2020. Analysis used appropriate statistics.</p></div><div><h3>Results</h3><p>Of 269 patients undergoing NO, 213 (79.2 %) survived to discharge. Non-survivors had longer bypass times, delayed sternal closure, required nitric oxide, higher vasoactive scores, required post-operative catheterization, Extracorporeal Life Support (ECLS), and longer ventilation (p < 0.05). Logistic regression showed moderate-severe atrioventricular valve regurgitation on intraoperative TEE (OR 2.6), requiring nitric oxide (OR 2.63), delayed sternal closure (OR 2.94), post-operative catheterization (OR 10.48), and ECLS (OR 14.54) increased mortality odds (p < 0.05). Multivariable analysis confirmed catheterization (aOR 10.48) and ECLS (aOR 14.54) as significant predictors. Of survivors, 26 (12.3 %) developed new morbidity, 9 (4.2 %) had unfavorable outcomes. Functional status improved from 6.0 to 8.04, mainly in feeding and respiratory domains (p < 0.0001).</p></div><div><h3>Conclusions</h3><p>Norwood survival was 79.2 %. Requiring post-operative catheterization and ECLS significantly increased mortality risk. Multicenter evaluation of these modifiable risk factors is needed to improve outcomes in this high-risk population.</p></div>\",\"PeriodicalId\":73429,\"journal\":{\"name\":\"International journal of cardiology. 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Outcomes, mortality risk factors, and functional status post-Norwood: A single-center study
Background
The Norwood operation (NO) for infants with univentricular physiology has high interstage mortality. This study evaluated outcomes and risk factors for mortality following NO.
Methods
Retrospective single-center study of patients undergoing NO from 2010 to 2020. Analysis used appropriate statistics.
Results
Of 269 patients undergoing NO, 213 (79.2 %) survived to discharge. Non-survivors had longer bypass times, delayed sternal closure, required nitric oxide, higher vasoactive scores, required post-operative catheterization, Extracorporeal Life Support (ECLS), and longer ventilation (p < 0.05). Logistic regression showed moderate-severe atrioventricular valve regurgitation on intraoperative TEE (OR 2.6), requiring nitric oxide (OR 2.63), delayed sternal closure (OR 2.94), post-operative catheterization (OR 10.48), and ECLS (OR 14.54) increased mortality odds (p < 0.05). Multivariable analysis confirmed catheterization (aOR 10.48) and ECLS (aOR 14.54) as significant predictors. Of survivors, 26 (12.3 %) developed new morbidity, 9 (4.2 %) had unfavorable outcomes. Functional status improved from 6.0 to 8.04, mainly in feeding and respiratory domains (p < 0.0001).
Conclusions
Norwood survival was 79.2 %. Requiring post-operative catheterization and ECLS significantly increased mortality risk. Multicenter evaluation of these modifiable risk factors is needed to improve outcomes in this high-risk population.
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