Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt
Background The purpose of this study was to describe the experience with staged surgical reconstruction of the hypoplastic left heart syndrome (HLHS) with a right ventricle to pulmonary artery conduit and to identify the risk factors that influence late outcome. Methods Between February 1998 and Jun...
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| Veröffentlicht in: | The Annals of thoracic surgery 2009, Vol.87 (1), p.178-186 |
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| creator | Sano, Shunji, MD Huang, Shu-Chien, MD Kasahara, Shingo, MD Yoshizumi, Ko, MD Kotani, Yasuhiro, MD Ishino, Kozo, MD |
| description | Background The purpose of this study was to describe the experience with staged surgical reconstruction of the hypoplastic left heart syndrome (HLHS) with a right ventricle to pulmonary artery conduit and to identify the risk factors that influence late outcome. Methods Between February 1998 and June 2007, 62 patients with HLHS underwent a Norwood procedure by using right ventricle to pulmonary artery conduit (median age, 9 days [range, 1 to 57]; median body weight 2.7 kg [range, 1.6 to 3.9 kg]). The subsequent 47 patients underwent a bidirectional Glenn procedure (stage 2). Thirty-two patients underwent a modified Fontan procedure (stage 3). Follow-up was complete (median, 32 months; range, 1 to 101). Results Hospital mortality after the Norwood procedure was 8% (5 of 62 patients). Between stages, 9 patients died, 3 before stage 2 and 6 before stage 3. There was 1 late death after stage 3. Overall survival was 76% (47 of 62). The estimated 1-year and and 5-year survival rates were 80% and 73%, respectively. Using the any-mortality as the endpoint, prematurity (gestational age |
| doi_str_mv | 10.1016/j.athoracsur.2008.08.027 |
| format | Article |
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Methods Between February 1998 and June 2007, 62 patients with HLHS underwent a Norwood procedure by using right ventricle to pulmonary artery conduit (median age, 9 days [range, 1 to 57]; median body weight 2.7 kg [range, 1.6 to 3.9 kg]). The subsequent 47 patients underwent a bidirectional Glenn procedure (stage 2). Thirty-two patients underwent a modified Fontan procedure (stage 3). Follow-up was complete (median, 32 months; range, 1 to 101). Results Hospital mortality after the Norwood procedure was 8% (5 of 62 patients). Between stages, 9 patients died, 3 before stage 2 and 6 before stage 3. There was 1 late death after stage 3. Overall survival was 76% (47 of 62). The estimated 1-year and and 5-year survival rates were 80% and 73%, respectively. Using the any-mortality as the endpoint, prematurity (gestational age <37 weeks), body weight less than 2.5 kg at stage 1 operation, and tricuspid regurgitation 2+ or more were associated with mortality. Using Cox regression analysis, body weight less than 2.5 kg and tricuspid regurgitation 2+ or more were two independent factors associated with midterm survival. Conclusions From 9 years of experience, despite good early survival after Norwood stage 1 palliation, low body weight and tricuspid valve regurgitation were still associated with worse outcome. More efforts should be made to improve the late results for patients with hypoplastic left heart syndrome.</description><identifier>ISSN: 0003-4975</identifier><identifier>EISSN: 1552-6259</identifier><identifier>DOI: 10.1016/j.athoracsur.2008.08.027</identifier><identifier>PMID: 19101293</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Cardiopulmonary Bypass ; Cardiothoracic Surgery ; Cardiovascular Surgical Procedures - methods ; Cardiovascular Surgical Procedures - mortality ; Cause of Death ; Cohort Studies ; Education, Medical, Continuing ; Female ; Follow-Up Studies ; Fontan Procedure - methods ; Fontan Procedure - mortality ; Heart Bypass, Right - methods ; Heart Bypass, Right - mortality ; Heart Ventricles - surgery ; Hospital Mortality - trends ; Humans ; Hypoplastic Left Heart Syndrome - diagnosis ; Hypoplastic Left Heart Syndrome - mortality ; Hypoplastic Left Heart Syndrome - surgery ; Infant ; Infant, Newborn ; Kaplan-Meier Estimate ; Male ; Multivariate Analysis ; Palliative Care - methods ; Postoperative Complications - mortality ; Probability ; Proportional Hazards Models ; Pulmonary Artery - surgery ; Reoperation - methods ; Retrospective Studies ; Risk Assessment ; Sensitivity and Specificity ; Surgery ; Survival Rate ; Time Factors</subject><ispartof>The Annals of thoracic surgery, 2009, Vol.87 (1), p.178-186</ispartof><rights>The Society of Thoracic Surgeons</rights><rights>2009 The Society of Thoracic Surgeons</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c578t-aada01ed5988fe17945fdd04e14b5b6b772979634077cc5a6b78f590fb3c00383</citedby><cites>FETCH-LOGICAL-c578t-aada01ed5988fe17945fdd04e14b5b6b772979634077cc5a6b78f590fb3c00383</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,4010,27900,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19101293$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sano, Shunji, MD</creatorcontrib><creatorcontrib>Huang, Shu-Chien, MD</creatorcontrib><creatorcontrib>Kasahara, Shingo, MD</creatorcontrib><creatorcontrib>Yoshizumi, Ko, MD</creatorcontrib><creatorcontrib>Kotani, Yasuhiro, MD</creatorcontrib><creatorcontrib>Ishino, Kozo, MD</creatorcontrib><title>Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt</title><title>The Annals of thoracic surgery</title><addtitle>Ann Thorac Surg</addtitle><description>Background The purpose of this study was to describe the experience with staged surgical reconstruction of the hypoplastic left heart syndrome (HLHS) with a right ventricle to pulmonary artery conduit and to identify the risk factors that influence late outcome. Methods Between February 1998 and June 2007, 62 patients with HLHS underwent a Norwood procedure by using right ventricle to pulmonary artery conduit (median age, 9 days [range, 1 to 57]; median body weight 2.7 kg [range, 1.6 to 3.9 kg]). The subsequent 47 patients underwent a bidirectional Glenn procedure (stage 2). Thirty-two patients underwent a modified Fontan procedure (stage 3). Follow-up was complete (median, 32 months; range, 1 to 101). Results Hospital mortality after the Norwood procedure was 8% (5 of 62 patients). Between stages, 9 patients died, 3 before stage 2 and 6 before stage 3. There was 1 late death after stage 3. Overall survival was 76% (47 of 62). The estimated 1-year and and 5-year survival rates were 80% and 73%, respectively. Using the any-mortality as the endpoint, prematurity (gestational age <37 weeks), body weight less than 2.5 kg at stage 1 operation, and tricuspid regurgitation 2+ or more were associated with mortality. Using Cox regression analysis, body weight less than 2.5 kg and tricuspid regurgitation 2+ or more were two independent factors associated with midterm survival. Conclusions From 9 years of experience, despite good early survival after Norwood stage 1 palliation, low body weight and tricuspid valve regurgitation were still associated with worse outcome. More efforts should be made to improve the late results for patients with hypoplastic left heart syndrome.</description><subject>Cardiopulmonary Bypass</subject><subject>Cardiothoracic Surgery</subject><subject>Cardiovascular Surgical Procedures - methods</subject><subject>Cardiovascular Surgical Procedures - mortality</subject><subject>Cause of Death</subject><subject>Cohort Studies</subject><subject>Education, Medical, Continuing</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fontan Procedure - methods</subject><subject>Fontan Procedure - mortality</subject><subject>Heart Bypass, Right - methods</subject><subject>Heart Bypass, Right - mortality</subject><subject>Heart Ventricles - surgery</subject><subject>Hospital Mortality - trends</subject><subject>Humans</subject><subject>Hypoplastic Left Heart Syndrome - diagnosis</subject><subject>Hypoplastic Left Heart Syndrome - mortality</subject><subject>Hypoplastic Left Heart Syndrome - surgery</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Multivariate Analysis</subject><subject>Palliative Care - methods</subject><subject>Postoperative Complications - mortality</subject><subject>Probability</subject><subject>Proportional Hazards Models</subject><subject>Pulmonary Artery - surgery</subject><subject>Reoperation - methods</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Sensitivity and Specificity</subject><subject>Surgery</subject><subject>Survival Rate</subject><subject>Time Factors</subject><issn>0003-4975</issn><issn>1552-6259</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkVFrFDEQx4Mo9qx-BcmTb3sm2c1m8yLUYlWoWlrra8hmJ71c9zbtJKvctzfLHRR8EgZCJv__TOY3hFDO1pzx9v12bfMmonVpxrVgrFsvIdQzsuJSiqoVUj8nK8ZYXTVayRPyKqVtuYry_JKccF3KCF2viL8O6Z5eWJcjJuoj0m8Rsx1D3tMznwFp3gD9HvFPjAO9wuhgmBHobQrTHb0Od5tMf8GUMbgRaI70ah53cbJY7Fjse3qzmaf8mrzwdkzw5niektuLTz_Pv1SXPz5_PT-7rJxUXa6sHSzjMEjddR640o30w8Aa4E0v-7ZXSmil27phSjknbcl0Xmrm-9qVWbv6lLw71H3A-DhDymYXkoNxtBPEOZm2VU1b80XYHYQOY0oI3jxg2JVvG87MwthszRNjszA2SwhVrG-PPeZ-B8OT8Qi1CD4eBFAm_R0ATXIBpkIuILhshhj-p8uHf4q4MUzB2fEe9pC2ccapkDTcJGGYuVl2vayadYx3vG7qv0b-qJ4</recordid><startdate>2009</startdate><enddate>2009</enddate><creator>Sano, Shunji, MD</creator><creator>Huang, Shu-Chien, MD</creator><creator>Kasahara, Shingo, MD</creator><creator>Yoshizumi, Ko, MD</creator><creator>Kotani, Yasuhiro, MD</creator><creator>Ishino, Kozo, MD</creator><general>Elsevier Inc</general><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>2009</creationdate><title>Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt</title><author>Sano, Shunji, MD ; Huang, Shu-Chien, MD ; Kasahara, Shingo, MD ; Yoshizumi, Ko, MD ; Kotani, Yasuhiro, MD ; Ishino, Kozo, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c578t-aada01ed5988fe17945fdd04e14b5b6b772979634077cc5a6b78f590fb3c00383</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Cardiopulmonary Bypass</topic><topic>Cardiothoracic Surgery</topic><topic>Cardiovascular Surgical Procedures - methods</topic><topic>Cardiovascular Surgical Procedures - mortality</topic><topic>Cause of Death</topic><topic>Cohort Studies</topic><topic>Education, Medical, Continuing</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fontan Procedure - methods</topic><topic>Fontan Procedure - mortality</topic><topic>Heart Bypass, Right - methods</topic><topic>Heart Bypass, Right - mortality</topic><topic>Heart Ventricles - surgery</topic><topic>Hospital Mortality - trends</topic><topic>Humans</topic><topic>Hypoplastic Left Heart Syndrome - diagnosis</topic><topic>Hypoplastic Left Heart Syndrome - mortality</topic><topic>Hypoplastic Left Heart Syndrome - surgery</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Multivariate Analysis</topic><topic>Palliative Care - methods</topic><topic>Postoperative Complications - mortality</topic><topic>Probability</topic><topic>Proportional Hazards Models</topic><topic>Pulmonary Artery - surgery</topic><topic>Reoperation - methods</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Sensitivity and Specificity</topic><topic>Surgery</topic><topic>Survival Rate</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sano, Shunji, MD</creatorcontrib><creatorcontrib>Huang, Shu-Chien, MD</creatorcontrib><creatorcontrib>Kasahara, Shingo, MD</creatorcontrib><creatorcontrib>Yoshizumi, Ko, MD</creatorcontrib><creatorcontrib>Kotani, Yasuhiro, MD</creatorcontrib><creatorcontrib>Ishino, Kozo, MD</creatorcontrib><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 Annals of thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sano, Shunji, MD</au><au>Huang, Shu-Chien, MD</au><au>Kasahara, Shingo, MD</au><au>Yoshizumi, Ko, MD</au><au>Kotani, Yasuhiro, MD</au><au>Ishino, Kozo, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt</atitle><jtitle>The Annals of thoracic surgery</jtitle><addtitle>Ann Thorac Surg</addtitle><date>2009</date><risdate>2009</risdate><volume>87</volume><issue>1</issue><spage>178</spage><epage>186</epage><pages>178-186</pages><issn>0003-4975</issn><eissn>1552-6259</eissn><abstract>Background The purpose of this study was to describe the experience with staged surgical reconstruction of the hypoplastic left heart syndrome (HLHS) with a right ventricle to pulmonary artery conduit and to identify the risk factors that influence late outcome. Methods Between February 1998 and June 2007, 62 patients with HLHS underwent a Norwood procedure by using right ventricle to pulmonary artery conduit (median age, 9 days [range, 1 to 57]; median body weight 2.7 kg [range, 1.6 to 3.9 kg]). The subsequent 47 patients underwent a bidirectional Glenn procedure (stage 2). Thirty-two patients underwent a modified Fontan procedure (stage 3). Follow-up was complete (median, 32 months; range, 1 to 101). Results Hospital mortality after the Norwood procedure was 8% (5 of 62 patients). Between stages, 9 patients died, 3 before stage 2 and 6 before stage 3. There was 1 late death after stage 3. Overall survival was 76% (47 of 62). The estimated 1-year and and 5-year survival rates were 80% and 73%, respectively. Using the any-mortality as the endpoint, prematurity (gestational age <37 weeks), body weight less than 2.5 kg at stage 1 operation, and tricuspid regurgitation 2+ or more were associated with mortality. Using Cox regression analysis, body weight less than 2.5 kg and tricuspid regurgitation 2+ or more were two independent factors associated with midterm survival. Conclusions From 9 years of experience, despite good early survival after Norwood stage 1 palliation, low body weight and tricuspid valve regurgitation were still associated with worse outcome. More efforts should be made to improve the late results for patients with hypoplastic left heart syndrome.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>19101293</pmid><doi>10.1016/j.athoracsur.2008.08.027</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Cardiopulmonary Bypass Cardiothoracic Surgery Cardiovascular Surgical Procedures - methods Cardiovascular Surgical Procedures - mortality Cause of Death Cohort Studies Education, Medical, Continuing Female Follow-Up Studies Fontan Procedure - methods Fontan Procedure - mortality Heart Bypass, Right - methods Heart Bypass, Right - mortality Heart Ventricles - surgery Hospital Mortality - trends Humans Hypoplastic Left Heart Syndrome - diagnosis Hypoplastic Left Heart Syndrome - mortality Hypoplastic Left Heart Syndrome - surgery Infant Infant, Newborn Kaplan-Meier Estimate Male Multivariate Analysis Palliative Care - methods Postoperative Complications - mortality Probability Proportional Hazards Models Pulmonary Artery - surgery Reoperation - methods Retrospective Studies Risk Assessment Sensitivity and Specificity Surgery Survival Rate Time Factors |
| title | Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt |
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