title: Impact of preoperative treatment strategies on the early perioperative outcome in neonates with hypoplastic left heart syndrome.
abstract: OBJECTIVE
  This study was undertaken to determine the impact of specific intensive care procedures on preoperative hemodynamics, incidence of preoperative organ dysfunction, and in-hospital mortality among neonates with hypoplastic left heart syndrome with pulmonary overcirculation and to assess the influence of the change in preoperative management on early postoperative outcome.
  
  
  METHODS
  In this retrospective evaluation of 72 neonates with classic hypoplastic left heart syndrome and severe pulmonary overcirculation with different preoperative management strategies from 1992 to 1995 and from 1996 to 2000, univariate and multivariate analyses of risk factors were performed with stepwise logistic regression.
  
  
  RESULTS
  Among patients with ventilatory and inotropic support from admission until surgery, degree of metabolic acidosis (lowest recorded and prerepair pH values) was significantly higher than among patients who received systemic vasodilators without ventilation before surgery. Preoperative organ dysfunction occurred in 19 of 72 patients (26%), predominantly before 1996; the most significant was hepatic failure in 13 (68%). Lowest recorded and prerepair pH values did not predict the development of organ dysfunction, whereas inotropic medication, lack of afterload reduction, and especially ventilatory support correlated significantly with organ injury. In-hospital mortality decreased from 65% (13/20) to 13% (6/46) from the first to the second period. According to multivariate analysis, ventilatory support and organ dysfunction were significantly related to in-hospital mortality.
  
  
  CONCLUSIONS
  In neonates with hypoplastic left heart syndrome, systemic afterload reduction can avoid preoperative artificial respiration, identified as a significant risk factor for the development of preoperative dysfunction of end organs and in-hospital mortality.
authors: Department of Pediatric Cardiology, University Hospital Schleswig Holstein-Campus Kiel, Kiel, Germany.
authors: Jürgen
authors: J
authors: Stieh
authors: Gunther
authors: G
authors: Fischer
authors: Jens
authors: J
authors: Scheewe
authors: Anselm
authors: A
authors: Uebing
authors: Peter
authors: P
authors: Dütschke
authors: Olaf
authors: O
authors: Jung
authors: Ralph
authors: R
authors: Grabitz
authors: Hans Joachim
authors: HJ
authors: Trampisch
authors: Hans Heiner
authors: HH
authors: Kramer