| Autor: |
Gardner MM; 1 Department of Critical Care Medicine University of Pittsburgh School of Medicine Pittsburgh PA., Mercer-Rosa L; 2 Division of Cardiology Department of Pediatrics The Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA., Faerber J; 3 Department of Pediatrics The Children's Hospital of Philadelphia Philadelphia PA., DiLorenzo MP; 4 Division of Pediatric Cardiology Department of Pediatrics New York Presbyterian/Morgan Stanley Children's Hospital Columbia University Irving Medical Center New York NY., Bates KE; 5 Division of Pediatric Cardiology Department of Pediatrics and Communicable Diseases C.S. Mott Children's Hospital University of Michigan Medical School Ann Arbor MI., Stagg A; 6 Division of Cardiology The Children's Hospital of Philadelphia, and The University of Pennsylvania School of Nursing Philadelphia PA., Natarajan SS; 2 Division of Cardiology Department of Pediatrics The Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA., Szwast A; 2 Division of Cardiology Department of Pediatrics The Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA., Fuller S; 7 Division of Cardiothoracic Surgery The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA., Mascio CE; 7 Division of Cardiothoracic Surgery The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA., Fleck D; 6 Division of Cardiology The Children's Hospital of Philadelphia, and The University of Pennsylvania School of Nursing Philadelphia PA., Torowicz DL; 6 Division of Cardiology The Children's Hospital of Philadelphia, and The University of Pennsylvania School of Nursing Philadelphia PA., Giglia TM; 2 Division of Cardiology Department of Pediatrics The Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA., Rome JJ; 2 Division of Cardiology Department of Pediatrics The Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA., Ravishankar C; 2 Division of Cardiology Department of Pediatrics The Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA. |
| Jazyk: |
angličtina |
| Zdroj: |
Journal of the American Heart Association [J Am Heart Assoc] 2019 May 21; Vol. 8 (10), pp. e010783. |
| DOI: |
10.1161/JAHA.118.010783 |
| Abstrakt: |
Background In shunt-dependent, single-ventricle patients, mortality remains high in the interstage period between discharge after neonatal surgery and stage 2 operation. We sought to evaluate the impact of our infant single-ventricle management and monitoring program ( ISVMP ) on interstage mortality and stage 2 outcomes. Methods and Results This retrospective single-center cohort study compared patients enrolled in ISVMP at hospital discharge with historical controls. The relationship of ISVMP to interstage mortality was determined with a bivariate probit model for the joint modeling of both groups, using an instrumental variables approach. We included 166 ISVMP participants (December 1, 2010, to June 30, 2015) and 168 controls (January 1, 2007, to November 30, 2010). The groups did not differ by anatomy, gender, race, or genetic syndrome. Mortality was lower in the ISVMP group (5.4%) versus controls (13%). An ISVMP infant compared with a historical control had an average 29% lower predicted probability of interstage death (adjusted probability: -0.29; 95% CI , -0.52 to -0.057; P=0.015). On stratified analysis, mortality was lower in the hypoplastic left heart syndrome subgroup undergoing Norwood operation (4/84 [4.8%] versus 12/90 [14%], P=0.03) but not in those with initial palliation of shunt only ( P=0.90). ISVMP participants were younger at the time of the stage 2 operation (138 versus 160 days, P<0.001), with no difference in postoperative mortality or length of stay. Conclusions In this single-center study, we report significantly lower interstage mortality for participants with hypoplastic left heart syndrome enrolled in ISVMP . Younger age at stage 2 operation was not associated with postoperative mortality or longer length of stay. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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