Superior cavopulmonary anastomosis timing and outcomes in infants with single ventricle

James F. Cnota, Kerstin R. Allen, Steven Colan, Wesley Covitz, Eric M. Graham, David A. Hehir, Jami C. Levine, Renee Margossian, Brian W. McCrindle, L. Luann Minich, Shobha Natarajan, Marc E. Richmond, Daphne T. Hsu

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objectives: We sought to identify factors associated with the timing and surgical outcomes of the superior cavopulmonary anastomosis. Methods: The Pediatric Heart Network's Infant Single Ventricle trial database identified participants who underwent superior cavopulmonary anastomosis. Factors potentially associated with age at superior cavopulmonary anastomosis, length of stay and death by 14 months of age were evaluated. Factors included subject demographics, cardiac anatomy, measures from neonatal hospitalization and pre-superior cavopulmonary anastomosis visit, adverse events, echocardiographic variables, intraoperative variables, superior cavopulmonary anastomosis type, and number of concurrent cardiac surgical procedures. Age at superior cavopulmonary anastomosis was analyzed using Cox proportional hazards regression. Natural log length of stay was analyzed by multiple linear regression. Results: Superior cavopulmonary anastomosis was performed in 193 subjects at 5.2 months of age (interquartile range, 4.2, 6.2) and weight of 5.9 kg (interquartile range, 5.3, 6.6). The median length of stay was 7 days (interquartile range, 6, 10). There were 3 deaths and 1 transplant during the superior cavopulmonary anastomosis hospitalization, and 3 deaths and 3 transplants between discharge and 14 months of age. Age at superior cavopulmonary anastomosis was associated with center and interstage adverse events. A longer length of stay was associated with younger age and greater case complexity. Superior cavopulmonary anastomosis type, valve regurgitation, ventricular ejection fraction, and ventricular end-diastolic pressure were not independently associated with age at superior cavopulmonary anastomosis or the length of stay. Conclusions: Greater case complexity and more frequent interstage adverse events are associated with an earlier age at superior cavopulmonary anastomosis. Significant variation in age at superior cavopulmonary anastomosis among centers, independent of subject factors, highlights a lack of consensus regarding the optimal timing. Factors associated with length of stay could offer insights for improving presuperior cavopulmonary anastomosis care and surgical outcome.

Original languageEnglish (US)
Pages (from-to)1288-1296
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume145
Issue number5
DOIs
StatePublished - May 2013
Externally publishedYes

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Right Heart Bypass
Length of Stay
Hospitalization
Cardiac Surgical Procedures
Transplants

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Superior cavopulmonary anastomosis timing and outcomes in infants with single ventricle. / Cnota, James F.; Allen, Kerstin R.; Colan, Steven; Covitz, Wesley; Graham, Eric M.; Hehir, David A.; Levine, Jami C.; Margossian, Renee; McCrindle, Brian W.; Minich, L. Luann; Natarajan, Shobha; Richmond, Marc E.; Hsu, Daphne T.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 145, No. 5, 05.2013, p. 1288-1296.

Research output: Contribution to journalArticle

Cnota, JF, Allen, KR, Colan, S, Covitz, W, Graham, EM, Hehir, DA, Levine, JC, Margossian, R, McCrindle, BW, Minich, LL, Natarajan, S, Richmond, ME & Hsu, DT 2013, 'Superior cavopulmonary anastomosis timing and outcomes in infants with single ventricle', Journal of Thoracic and Cardiovascular Surgery, vol. 145, no. 5, pp. 1288-1296. https://doi.org/10.1016/j.jtcvs.2012.07.069
Cnota, James F. ; Allen, Kerstin R. ; Colan, Steven ; Covitz, Wesley ; Graham, Eric M. ; Hehir, David A. ; Levine, Jami C. ; Margossian, Renee ; McCrindle, Brian W. ; Minich, L. Luann ; Natarajan, Shobha ; Richmond, Marc E. ; Hsu, Daphne T. / Superior cavopulmonary anastomosis timing and outcomes in infants with single ventricle. In: Journal of Thoracic and Cardiovascular Surgery. 2013 ; Vol. 145, No. 5. pp. 1288-1296.
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abstract = "Objectives: We sought to identify factors associated with the timing and surgical outcomes of the superior cavopulmonary anastomosis. Methods: The Pediatric Heart Network's Infant Single Ventricle trial database identified participants who underwent superior cavopulmonary anastomosis. Factors potentially associated with age at superior cavopulmonary anastomosis, length of stay and death by 14 months of age were evaluated. Factors included subject demographics, cardiac anatomy, measures from neonatal hospitalization and pre-superior cavopulmonary anastomosis visit, adverse events, echocardiographic variables, intraoperative variables, superior cavopulmonary anastomosis type, and number of concurrent cardiac surgical procedures. Age at superior cavopulmonary anastomosis was analyzed using Cox proportional hazards regression. Natural log length of stay was analyzed by multiple linear regression. Results: Superior cavopulmonary anastomosis was performed in 193 subjects at 5.2 months of age (interquartile range, 4.2, 6.2) and weight of 5.9 kg (interquartile range, 5.3, 6.6). The median length of stay was 7 days (interquartile range, 6, 10). There were 3 deaths and 1 transplant during the superior cavopulmonary anastomosis hospitalization, and 3 deaths and 3 transplants between discharge and 14 months of age. Age at superior cavopulmonary anastomosis was associated with center and interstage adverse events. A longer length of stay was associated with younger age and greater case complexity. Superior cavopulmonary anastomosis type, valve regurgitation, ventricular ejection fraction, and ventricular end-diastolic pressure were not independently associated with age at superior cavopulmonary anastomosis or the length of stay. Conclusions: Greater case complexity and more frequent interstage adverse events are associated with an earlier age at superior cavopulmonary anastomosis. Significant variation in age at superior cavopulmonary anastomosis among centers, independent of subject factors, highlights a lack of consensus regarding the optimal timing. Factors associated with length of stay could offer insights for improving presuperior cavopulmonary anastomosis care and surgical outcome.",
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AU - Allen, Kerstin R.

AU - Colan, Steven

AU - Covitz, Wesley

AU - Graham, Eric M.

AU - Hehir, David A.

AU - Levine, Jami C.

AU - Margossian, Renee

AU - McCrindle, Brian W.

AU - Minich, L. Luann

AU - Natarajan, Shobha

AU - Richmond, Marc E.

AU - Hsu, Daphne T.

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N2 - Objectives: We sought to identify factors associated with the timing and surgical outcomes of the superior cavopulmonary anastomosis. Methods: The Pediatric Heart Network's Infant Single Ventricle trial database identified participants who underwent superior cavopulmonary anastomosis. Factors potentially associated with age at superior cavopulmonary anastomosis, length of stay and death by 14 months of age were evaluated. Factors included subject demographics, cardiac anatomy, measures from neonatal hospitalization and pre-superior cavopulmonary anastomosis visit, adverse events, echocardiographic variables, intraoperative variables, superior cavopulmonary anastomosis type, and number of concurrent cardiac surgical procedures. Age at superior cavopulmonary anastomosis was analyzed using Cox proportional hazards regression. Natural log length of stay was analyzed by multiple linear regression. Results: Superior cavopulmonary anastomosis was performed in 193 subjects at 5.2 months of age (interquartile range, 4.2, 6.2) and weight of 5.9 kg (interquartile range, 5.3, 6.6). The median length of stay was 7 days (interquartile range, 6, 10). There were 3 deaths and 1 transplant during the superior cavopulmonary anastomosis hospitalization, and 3 deaths and 3 transplants between discharge and 14 months of age. Age at superior cavopulmonary anastomosis was associated with center and interstage adverse events. A longer length of stay was associated with younger age and greater case complexity. Superior cavopulmonary anastomosis type, valve regurgitation, ventricular ejection fraction, and ventricular end-diastolic pressure were not independently associated with age at superior cavopulmonary anastomosis or the length of stay. Conclusions: Greater case complexity and more frequent interstage adverse events are associated with an earlier age at superior cavopulmonary anastomosis. Significant variation in age at superior cavopulmonary anastomosis among centers, independent of subject factors, highlights a lack of consensus regarding the optimal timing. Factors associated with length of stay could offer insights for improving presuperior cavopulmonary anastomosis care and surgical outcome.

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