Biventricular strategies for neonatal critical aortic stenosis: High mortality associated with early reintervention
Objective To characterize the risk of reintervention after biventricular strategies to treat neonatal critical aortic stenosis, and the effect of reintervention on survival. Methods In a multi-institutional inception cohort of 139 neonates, the time-related risk of reintervention was analyzed using...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2012-08, Vol.144 (2), p.409-417.e1 |
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| creator | Hickey, Edward J., MD Caldarone, Christopher A., MD Blackstone, Eugene H., MD Williams, William G., MD Yeh, Tom, MD Pizarro, Christian, MD Lofland, Gary, MD Tchervenkov, Christo I., MD Pigula, Frank, MD McCrindle, Brian W., MD |
| description | Objective To characterize the risk of reintervention after biventricular strategies to treat neonatal critical aortic stenosis, and the effect of reintervention on survival. Methods In a multi-institutional inception cohort of 139 neonates, the time-related risk of reintervention was analyzed using parametric multiphase competing-risk models and a modulated renewal repeated-events method. The risk factors were identified through multivariate regression and selected with bootstrap resampling for reliability. Univentricular survival predictions were generated using the Congenital Heart Surgeons' Society Univentricular Repair Survival Advantage score. Results One half of survivors required reintervention within 3 years. The risk of undergoing early reintervention decreased with successive procedures ( P |
| doi_str_mv | 10.1016/j.jtcvs.2011.09.076 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1027372869</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0022522312000724</els_id><sourcerecordid>1027372869</sourcerecordid><originalsourceid>FETCH-LOGICAL-c489t-bdf0dc2590f4786da7a5e390379d136074570d2bcc1a4c8ac998b5989aadc7343</originalsourceid><addsrcrecordid>eNqFkt-L1DAQgIso3nr6FwiSF8GX1vxom0ZQ0EM94cAHFXwL2WR6l9pNzky6sv-9qbsq-OJThuGbmeTLVNVjRhtGWf98aqZs99hwylhDVUNlf6faMKpk3Q_d17vVhlLO645zcVY9QJwopZIydb86Kynet7zbVPjG7yHk5O0ym0QwJ5Ph2gOSMSYSIAaTzUxs8tnbEpiYSlA4CBE9viCX_vqG7ErWzD4fiEGM1pcejvzw-YaASfOBJPAhQ1on-RgeVvdGMyM8Op3n1Zd3bz9fXNZXH99_uHh9Vdt2ULneupE6yztFx1YOvTPSdCAUFVI5Jnoq205Sx7fWMtPawVilhm2nBmWMs1K04rx6dux7m-L3BTDrnUcL82zKuxbUjHIpJB96VVBxRG2KiAlGfZv8zqRDgfRqW0_6l2292tZU6WK7VD05DVi2O3B_an7rLcDTE2Cw2BuTCdbjX65npYsUhXt55KDo2HtIGq2HYMH5BDZrF_1_LvLqn3o7-7B-2Dc4AE5xSaGY1kwj11R_Whdj3QvG153grfgJiz22ZQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1027372869</pqid></control><display><type>article</type><title>Biventricular strategies for neonatal critical aortic stenosis: High mortality associated with early reintervention</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Hickey, Edward J., MD ; Caldarone, Christopher A., MD ; Blackstone, Eugene H., MD ; Williams, William G., MD ; Yeh, Tom, MD ; Pizarro, Christian, MD ; Lofland, Gary, MD ; Tchervenkov, Christo I., MD ; Pigula, Frank, MD ; McCrindle, Brian W., MD</creator><creatorcontrib>Hickey, Edward J., MD ; Caldarone, Christopher A., MD ; Blackstone, Eugene H., MD ; Williams, William G., MD ; Yeh, Tom, MD ; Pizarro, Christian, MD ; Lofland, Gary, MD ; Tchervenkov, Christo I., MD ; Pigula, Frank, MD ; McCrindle, Brian W., MD ; Congenital Heart Surgeons' Society</creatorcontrib><description>Objective To characterize the risk of reintervention after biventricular strategies to treat neonatal critical aortic stenosis, and the effect of reintervention on survival. Methods In a multi-institutional inception cohort of 139 neonates, the time-related risk of reintervention was analyzed using parametric multiphase competing-risk models and a modulated renewal repeated-events method. The risk factors were identified through multivariate regression and selected with bootstrap resampling for reliability. Univentricular survival predictions were generated using the Congenital Heart Surgeons' Society Univentricular Repair Survival Advantage score. Results One half of survivors required reintervention within 3 years. The risk of undergoing early reintervention decreased with successive procedures ( P < .0001); however, second (n = 27) and third (n = 8) reinterventions were associated with a greater late risk of repeat reintervention compared with the index procedure ( P = .02). The morphologic risk factors for earlier reintervention included left ventricular dysfunction, fewer aortic cusps, associated subaortic or arch obstruction, and a larger tricuspid annulus. The risk of death did not improve after successive reinterventions. Therefore, the overall survival for those requiring repeated reinterventions was compromised by the cumulative procedural risk of death. The most important risk factor for death after the first reintervention ( P < .01) was a shorter interval from the index biventricular procedure, particularly if less than 30 days. Fifteen neonates required reintervention within 30 days of the index biventricular procedure (9 deaths, 60%). For the same 15 neonates, the survival predictions using published models estimated fewer than one half the number deaths with index univentricular repair strategies (4/15, 27%, P = .03). Conclusions Success of index biventricular procedures has important survival implications: early reintervention implies a poor prognosis and might reflect incorrect management decisions. The morphologic characteristics can help identify such neonates, and univentricular repair might, instead, be preferable.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2011.09.076</identifier><identifier>PMID: 22326425</identifier><identifier>CODEN: JTCSAQ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Aortic Valve Stenosis - mortality ; Aortic Valve Stenosis - physiopathology ; Aortic Valve Stenosis - therapy ; Biological and medical sciences ; Cardiac Surgical Procedures - methods ; Cardiac Surgical Procedures - mortality ; Cardiology. Vascular system ; Cardiothoracic Surgery ; Catheterization ; Female ; Heart Ventricles - surgery ; Humans ; Infant, Newborn ; Male ; Medical sciences ; Models, Statistical ; Pneumology ; Prognosis ; Risk Assessment ; Risk Factors ; Survival Analysis ; Ventricular Dysfunction, Left - epidemiology ; Ventricular Outflow Obstruction - physiopathology</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2012-08, Vol.144 (2), p.409-417.e1</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2012 The American Association for Thoracic Surgery</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c489t-bdf0dc2590f4786da7a5e390379d136074570d2bcc1a4c8ac998b5989aadc7343</citedby><cites>FETCH-LOGICAL-c489t-bdf0dc2590f4786da7a5e390379d136074570d2bcc1a4c8ac998b5989aadc7343</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522312000724$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26176373$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22326425$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hickey, Edward J., MD</creatorcontrib><creatorcontrib>Caldarone, Christopher A., MD</creatorcontrib><creatorcontrib>Blackstone, Eugene H., MD</creatorcontrib><creatorcontrib>Williams, William G., MD</creatorcontrib><creatorcontrib>Yeh, Tom, MD</creatorcontrib><creatorcontrib>Pizarro, Christian, MD</creatorcontrib><creatorcontrib>Lofland, Gary, MD</creatorcontrib><creatorcontrib>Tchervenkov, Christo I., MD</creatorcontrib><creatorcontrib>Pigula, Frank, MD</creatorcontrib><creatorcontrib>McCrindle, Brian W., MD</creatorcontrib><creatorcontrib>Congenital Heart Surgeons' Society</creatorcontrib><title>Biventricular strategies for neonatal critical aortic stenosis: High mortality associated with early reintervention</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objective To characterize the risk of reintervention after biventricular strategies to treat neonatal critical aortic stenosis, and the effect of reintervention on survival. Methods In a multi-institutional inception cohort of 139 neonates, the time-related risk of reintervention was analyzed using parametric multiphase competing-risk models and a modulated renewal repeated-events method. The risk factors were identified through multivariate regression and selected with bootstrap resampling for reliability. Univentricular survival predictions were generated using the Congenital Heart Surgeons' Society Univentricular Repair Survival Advantage score. Results One half of survivors required reintervention within 3 years. The risk of undergoing early reintervention decreased with successive procedures ( P < .0001); however, second (n = 27) and third (n = 8) reinterventions were associated with a greater late risk of repeat reintervention compared with the index procedure ( P = .02). The morphologic risk factors for earlier reintervention included left ventricular dysfunction, fewer aortic cusps, associated subaortic or arch obstruction, and a larger tricuspid annulus. The risk of death did not improve after successive reinterventions. Therefore, the overall survival for those requiring repeated reinterventions was compromised by the cumulative procedural risk of death. The most important risk factor for death after the first reintervention ( P < .01) was a shorter interval from the index biventricular procedure, particularly if less than 30 days. Fifteen neonates required reintervention within 30 days of the index biventricular procedure (9 deaths, 60%). For the same 15 neonates, the survival predictions using published models estimated fewer than one half the number deaths with index univentricular repair strategies (4/15, 27%, P = .03). Conclusions Success of index biventricular procedures has important survival implications: early reintervention implies a poor prognosis and might reflect incorrect management decisions. The morphologic characteristics can help identify such neonates, and univentricular repair might, instead, be preferable.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Aortic Valve Stenosis - mortality</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Aortic Valve Stenosis - therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiac Surgical Procedures - methods</subject><subject>Cardiac Surgical Procedures - mortality</subject><subject>Cardiology. Vascular system</subject><subject>Cardiothoracic Surgery</subject><subject>Catheterization</subject><subject>Female</subject><subject>Heart Ventricles - surgery</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Models, Statistical</subject><subject>Pneumology</subject><subject>Prognosis</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Survival Analysis</subject><subject>Ventricular Dysfunction, Left - epidemiology</subject><subject>Ventricular Outflow Obstruction - physiopathology</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkt-L1DAQgIso3nr6FwiSF8GX1vxom0ZQ0EM94cAHFXwL2WR6l9pNzky6sv-9qbsq-OJThuGbmeTLVNVjRhtGWf98aqZs99hwylhDVUNlf6faMKpk3Q_d17vVhlLO645zcVY9QJwopZIydb86Kynet7zbVPjG7yHk5O0ym0QwJ5Ph2gOSMSYSIAaTzUxs8tnbEpiYSlA4CBE9viCX_vqG7ErWzD4fiEGM1pcejvzw-YaASfOBJPAhQ1on-RgeVvdGMyM8Op3n1Zd3bz9fXNZXH99_uHh9Vdt2ULneupE6yztFx1YOvTPSdCAUFVI5Jnoq205Sx7fWMtPawVilhm2nBmWMs1K04rx6dux7m-L3BTDrnUcL82zKuxbUjHIpJB96VVBxRG2KiAlGfZv8zqRDgfRqW0_6l2292tZU6WK7VD05DVi2O3B_an7rLcDTE2Cw2BuTCdbjX65npYsUhXt55KDo2HtIGq2HYMH5BDZrF_1_LvLqn3o7-7B-2Dc4AE5xSaGY1kwj11R_Whdj3QvG153grfgJiz22ZQ</recordid><startdate>20120801</startdate><enddate>20120801</enddate><creator>Hickey, Edward J., MD</creator><creator>Caldarone, Christopher A., MD</creator><creator>Blackstone, Eugene H., MD</creator><creator>Williams, William G., MD</creator><creator>Yeh, Tom, MD</creator><creator>Pizarro, Christian, MD</creator><creator>Lofland, Gary, MD</creator><creator>Tchervenkov, Christo I., MD</creator><creator>Pigula, Frank, MD</creator><creator>McCrindle, Brian W., MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120801</creationdate><title>Biventricular strategies for neonatal critical aortic stenosis: High mortality associated with early reintervention</title><author>Hickey, Edward J., MD ; Caldarone, Christopher A., MD ; Blackstone, Eugene H., MD ; Williams, William G., MD ; Yeh, Tom, MD ; Pizarro, Christian, MD ; Lofland, Gary, MD ; Tchervenkov, Christo I., MD ; Pigula, Frank, MD ; McCrindle, Brian W., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c489t-bdf0dc2590f4786da7a5e390379d136074570d2bcc1a4c8ac998b5989aadc7343</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Aortic Valve Stenosis - mortality</topic><topic>Aortic Valve Stenosis - physiopathology</topic><topic>Aortic Valve Stenosis - therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiac Surgical Procedures - methods</topic><topic>Cardiac Surgical Procedures - mortality</topic><topic>Cardiology. Vascular system</topic><topic>Cardiothoracic Surgery</topic><topic>Catheterization</topic><topic>Female</topic><topic>Heart Ventricles - surgery</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Models, Statistical</topic><topic>Pneumology</topic><topic>Prognosis</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Survival Analysis</topic><topic>Ventricular Dysfunction, Left - epidemiology</topic><topic>Ventricular Outflow Obstruction - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hickey, Edward J., MD</creatorcontrib><creatorcontrib>Caldarone, Christopher A., MD</creatorcontrib><creatorcontrib>Blackstone, Eugene H., MD</creatorcontrib><creatorcontrib>Williams, William G., MD</creatorcontrib><creatorcontrib>Yeh, Tom, MD</creatorcontrib><creatorcontrib>Pizarro, Christian, MD</creatorcontrib><creatorcontrib>Lofland, Gary, MD</creatorcontrib><creatorcontrib>Tchervenkov, Christo I., MD</creatorcontrib><creatorcontrib>Pigula, Frank, MD</creatorcontrib><creatorcontrib>McCrindle, Brian W., MD</creatorcontrib><creatorcontrib>Congenital Heart Surgeons' Society</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hickey, Edward J., MD</au><au>Caldarone, Christopher A., MD</au><au>Blackstone, Eugene H., MD</au><au>Williams, William G., MD</au><au>Yeh, Tom, MD</au><au>Pizarro, Christian, MD</au><au>Lofland, Gary, MD</au><au>Tchervenkov, Christo I., MD</au><au>Pigula, Frank, MD</au><au>McCrindle, Brian W., MD</au><aucorp>Congenital Heart Surgeons' Society</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Biventricular strategies for neonatal critical aortic stenosis: High mortality associated with early reintervention</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2012-08-01</date><risdate>2012</risdate><volume>144</volume><issue>2</issue><spage>409</spage><epage>417.e1</epage><pages>409-417.e1</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><coden>JTCSAQ</coden><abstract>Objective To characterize the risk of reintervention after biventricular strategies to treat neonatal critical aortic stenosis, and the effect of reintervention on survival. Methods In a multi-institutional inception cohort of 139 neonates, the time-related risk of reintervention was analyzed using parametric multiphase competing-risk models and a modulated renewal repeated-events method. The risk factors were identified through multivariate regression and selected with bootstrap resampling for reliability. Univentricular survival predictions were generated using the Congenital Heart Surgeons' Society Univentricular Repair Survival Advantage score. Results One half of survivors required reintervention within 3 years. The risk of undergoing early reintervention decreased with successive procedures ( P < .0001); however, second (n = 27) and third (n = 8) reinterventions were associated with a greater late risk of repeat reintervention compared with the index procedure ( P = .02). The morphologic risk factors for earlier reintervention included left ventricular dysfunction, fewer aortic cusps, associated subaortic or arch obstruction, and a larger tricuspid annulus. The risk of death did not improve after successive reinterventions. Therefore, the overall survival for those requiring repeated reinterventions was compromised by the cumulative procedural risk of death. The most important risk factor for death after the first reintervention ( P < .01) was a shorter interval from the index biventricular procedure, particularly if less than 30 days. Fifteen neonates required reintervention within 30 days of the index biventricular procedure (9 deaths, 60%). For the same 15 neonates, the survival predictions using published models estimated fewer than one half the number deaths with index univentricular repair strategies (4/15, 27%, P = .03). Conclusions Success of index biventricular procedures has important survival implications: early reintervention implies a poor prognosis and might reflect incorrect management decisions. The morphologic characteristics can help identify such neonates, and univentricular repair might, instead, be preferable.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>22326425</pmid><doi>10.1016/j.jtcvs.2011.09.076</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Aortic Valve Stenosis - mortality Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - therapy Biological and medical sciences Cardiac Surgical Procedures - methods Cardiac Surgical Procedures - mortality Cardiology. Vascular system Cardiothoracic Surgery Catheterization Female Heart Ventricles - surgery Humans Infant, Newborn Male Medical sciences Models, Statistical Pneumology Prognosis Risk Assessment Risk Factors Survival Analysis Ventricular Dysfunction, Left - epidemiology Ventricular Outflow Obstruction - physiopathology |
| title | Biventricular strategies for neonatal critical aortic stenosis: High mortality associated with early reintervention |
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