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Younger age remains a risk factor for prolonged length of stay after bidirectional cavopulmonary anastomosis

Published online by Cambridge University Press:  30 January 2019

Andrew M. Koth Open the ORCID record for Andrew M. Koth [Opens in a new window] ,
Claudia A. Algaze ,
Charlotte Sakarovitch ,
Jin Long ,
Komal Kamra ,
Gail E. Wright ,
Bambi Alexander-Banys ,
Katsuhide Maeda  and
Andrew Y. Shin
Andrew M. Koth*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Claudia A. Algaze
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Charlotte Sakarovitch
Affiliation:
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Jin Long
Affiliation:
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Komal Kamra
Affiliation:
Department of Anesthesia, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Gail E. Wright
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Bambi Alexander-Banys
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Katsuhide Maeda
Affiliation:
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
Andrew Y. Shin
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA
*
Author for correspondence: Andrew Koth, Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA. E-mail: [email protected]
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Abstract

Objective

This study sets out to determine the influence of age at the time of surgery as a risk factor for post-operative length of stay after bidirectional cavopulmonary anastomosis.

Methods

All patients undergoing a Glenn procedure between January 2010 and July 2015 were included in this retrospective cohort study. Demographic data were examined. Standard descriptive statistics was used. A univariable analysis was conducted using the appropriate test based on data distribution. A propensity score for balancing the group difference was included in the multi-variable analysis, which was then completed using predictors from the univariable analysis that achieved significance of p<0.1.

Results

Over the study period, 50 patients met the inclusion criteria. Patients were separated into two cohorts of ⩾4 months (28 patients) and <4 months (22 patients). Other than height and weight, the two cohorts were indistinguishable in their pre-operative saturation, medications, catheterisation haemodynamics, atrioventricular valve regurgitation, and ventricular function. After adjusting group differences, younger age was associated with longer post-operative length of hospitalisation – adjusted mean 15 (±2.53) versus 8 (±2.15) days (p=0.03). In a multi-variable regression analysis, in addition to ventricular dysfunction (β coefficient=8.8, p=0.05), Glenn procedures performed before 4 months were independently associated with longer length of stay (β coefficient=−6.9, p=0.03).

Conclusion

We found that Glenn procedures performed after 4 months of age had shorter post-operative length of stay when compared to a younger cohort. These findings suggest that balancing timing of surgery to decrease the inter-stage period should take into consideration differences in post-operative recovery with earlier operations.

Keywords

CHDhypoplastic left heart syndromeGlennbidirectional cavopulmonary anastomosislength of staycongenital cardiac surgery
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 3 , March 2019 , pp. 369 - 374
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Copyright
© Cambridge University Press 2019 

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Footnotes

Cite this article: Koth AM, Algaze CA, Sakarovitch C, Long J, Kamra K, Wright GE, Alexander-Banys B, Maeda K, Shin AY. (2019) Younger age remains a risk factor for prolonged length of stay after bidirectional cavopulmonary anastomosis. Cardiology in the Young29: 369–374. doi: 10.1017/S1047951118002470

References

1. Lamberti, JJ, Spicer, RL, Waldman, JD, et al. The bidirectional cavopulmonary shunt. J Thorac Cardiovasc Surg 1990; 100: 22–29; discussion 29,30.Google Scholar
2. di Carlo, D, Williams, WG, Freedom, RM, Trusler, GA, Rowe, RD. The role of cava-pulmonary (Glenn) anastomosis in the palliative treatment of congenital heart disease. J Thorac Cardiovasc Surg 1982; 83: 437–442.Google Scholar
3. Jaquiss, RD, Ghanayem, NS, Hoffman, GM, et al. Early cavopulmonary anastomosis in very young infants after the Norwood procedure: impact on oxygenation, resource utilization, and mortality. J Thorac Cardiovasc Surg 2004; 127: 982–989.Google Scholar
4. Ashburn, DA, Blackstone, EH, Wells, WJ, et al. Determinants of mortality and type of repair in neonates with pulmonary atresia and intact ventricular septum. J Thorac Cardiovasc Surg 2004; 127: 1000–1007; discussion 1007,1008.10.1016/j.jtcvs.2003.11.057Google Scholar
5. Ghanayem, NS, Tweddell, JS, Hoffman, GM, Mussatto, K, Jaquiss, RD. Optimal timing of the second stage of palliation for hypoplastic left heart syndrome facilitated through home monitoring, and the results of early cavopulmonary anastomosis. Cardiol Young 2006; 16 (Suppl 1): 61–66.10.1017/S1047951105002349Google Scholar
6. Meza, JM, Hickey, E, McCrindle, B, et al. The optimal timing of stage-2-palliation after the Norwood operation. Ann Thorac Surg 2018; 105: 193–199.Google Scholar
7. Meza, JM, Hickey, EJ, Blackstone, EH, et al. The optimal timing of stage 2 palliation for hypoplastic left heart syndrome: an analysis of the pediatric heart network single ventricle reconstruction trial public data set. Circulation 2017; 136: 1737–1748.Google Scholar
8. Aeba, R, Katogi, T, Kashima, I, Omoto, T, Kawada, S, Omae, K. Factors influencing arterial oxygenation early after bidirectional cavopulmonary shunt without additional sources of pulmonary blood flow. J Thorac Cardiovasc Surg 2000; 120: 589–595.Google Scholar
9. Lee, TM, Aiyagari, R, Hirsch, JC, Ohye, RG, Bove, EL, Devaney, EJ. Risk factor analysis for second-stage palliation of single ventricle anatomy. Ann Thorac Surg 2012; 93: 614–618; discussion 619.10.1016/j.athoracsur.2011.10.012Google Scholar
10. Hansen, JH, Uebing, A, Furck, AK, et al. Risk factors for adverse outcome after superior cavopulmonary anastomosis for hypoplastic left heart syndrome. Eur J Cardiothorac Surg 2011; 40: e43–e49.Google Scholar
11. Petrucci, O, Khoury, PR, Manning, PB, Eghtesady, P. Outcomes of the bidirectional Glenn procedure in patients less than 3 months of age. J Thorac Cardiovasc Surg 2010; 139: 562–568.10.1016/j.jtcvs.2009.08.025Google Scholar
12. Baker-Smith, CM, Goldberg, SW, Rosenthal, GL. Predictors of prolonged hospital length of stay following stage ii palliation of hypoplastic left heart syndrome (and variants): analysis of the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) database. Pediatr Cardiol 2015; 36: 1630–1641.10.1007/s00246-015-1208-3Google Scholar
13. Siehr, SL, Norris, JK, Bushnell, JA, et al. Home monitoring program reduces interstage mortality after the modified Norwood procedure. J Thorac Cardiovasc Surg 2014; 147: 718–723.e1.Google Scholar
14. Reddy, VM, Liddicoat, JR, Hanley, FL. Primary bidirectional superior cavopulmonary shunt in infants between 1 and 4 months of age. Ann Thorac Surg 1995; 59: 1120–1125; discussion 1125,1126.Google Scholar
15. Reddy, VM, McElhinney, DB, Moore, P, Haas, GS, Hanley, FL. Outcomes after bidirectional cavopulmonary shunt in infants less than 6 months old. J Am Coll Cardiol 1997; 29: 1365–1370.10.1016/S0735-1097(97)00068-5Google Scholar
16. Anderson, JB, Beekman, RH 3rd, Kugler, JD, et al. Improvement in interstage survival in a national pediatric cardiology learning network. Circ Cardiovasc Qual Outcomes 2015; 8: 428–436.10.1161/CIRCOUTCOMES.115.001956Google Scholar
17. Anderson, JB, Beekman, RH 3rd, Border, WL, et al. Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. J Thorac Cardiovasc Surg 2009; 138: 397–404.e1.Google Scholar
18. Anderson, JB, Beekman, RH 3rd, Eghtesady, P, et al. Predictors of poor weight gain in infants with a single ventricle. J Pediatr 2010; 157: 407–413.e1.Google Scholar
19. Meza, JM, Jaquiss, RD, Anderson, BR, et al. Current practices in the timing of stage 2 palliation. World J Pediatr Congenit Heart Surg 2017; 8: 135–141.Google Scholar
20. Alexander-Banys, B, Axelrod, DM, Siehr, SL, Wright, GE. Interstage Nutritional Interventions Improve Growth and Shorten Length of Stay in Norwood Patients Undergoing Glenn at Four Months of Age. Pediatric Cardiac Intensive Care Society Meeting, Stanford University, 2014.Google Scholar