High Risk Status for Stage I Palliation Increases Mortality After Stage II But Not Stage III
| Autor: | Mario Castro-Medina, Luciana Da Fonseca Da Silva, Garrett N. Coyan, Melita Viegas, Victor O. Morell, Carlos E. Diaz-Castrillon |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Heart Ventricles Stage ii Univentricular Heart Cohort Studies Risk Factors Internal medicine Hypoplastic Left Heart Syndrome Risk of mortality medicine Humans Risk factor Stage (cooking) Retrospective Studies Risk status business.industry Palliative Care medicine.anatomical_structure Treatment Outcome Ventricle Single ventricle physiology Cohort Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of thoracic surgery. 114(4) |
| ISSN: | 1552-6259 |
| Popis: | Background High risk (HR) factors have been shown to have increased rates of mortality following Stage 1 palliation (S1P) for single ventricle physiology. It remains unclear how initial HR status affects longitudinal outcomes following subsequent Stage 2 (S2P) and Stage 3 (S3P) palliation. Methods Single ventricle patients undergoing S1P between July of 2004 and October of 2018 at a single institution were included. Patients having ≥ 1 HR factor were considered HR status, with all others classified as low risk (LR). Longitudinal survival stratified by risk status was compared following each palliative stage, in addition to re-admission and length of stay (LOS). Proportional hazard modeling was used to determine risk factors for longitudinal mortality. Results Of 132 patients presenting during the study for S1P, 57 (43.2%) were classified as HR. Overall 10-year survival was decreased in the HR cohort (p=0.001). HR patients were at significantly increased risk of death during Interstage I (p=0.01) and Interstage II (p=0.01), but survival was similar to LR patients following S3P (p=0.31). Re-admission rates following S2P were higher among HR patients (41.9% vs 22.5%, p=0.029), but were similar following S3P. LOS was increased in the HR cohort following S2P (median 11 vs 9 days, p=0.024) but similar to the LR group following S3P. Prematurity was the risk factor most consistently associated with increased mortality following all stages. Conclusions HR status for patients undergoing S1P portends a higher risk of mortality, LOS, and re-admission following S2P. HR patients enjoy similar survival to low-risk patients following S3P. |
| Databáze: | OpenAIRE |
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