title: Impact of early fundoplication or gastrostomy tube on midterm outcomes for patients with single ventricle.
abstract: OBJECTIVE
  Patients with single-ventricle heart disease experience early and late failure during and after staged palliation. Little is known about the factors related to continued risk of transplantation and mortality after completion of staged palliation. The long-term outcome of patients with single-ventricle disease who require a gastric fundoplication early in life has not been assessed.
  
  
  METHODS
  A total of 155 patients with single-ventricle disease who survived their first-stage palliative procedure were enrolled in a research registry. Demographic and anatomic variables were collected, and the families were contacted every 6 months for prospective documentation of transplant-free survival. Medical records were reviewed for the details of noncardiac surgical procedures. Univariate and multivariate regression analyses were performed to determine the impact of early gastric surgery on late transplant-free survival.
  
  
  RESULTS
  There were 93 male patients, median gestational age was 38 weeks, and birth weight was 3.2 kg. Sixty-five patients (42%) had hypoplastic left heart syndrome. Twelve patients (7.7%) had a genetic syndrome. Thirty-two patients (21%) had a fundoplication or a gastrostomy tube at less than 2 years of age. Median follow-up was 4.3 years (range, 79 days to 10 years). Race, gender, gestational age, birth weight, and genetic syndrome did not alter midterm transplant-free survival. Need for fundoplication or gastrostomy was an independent risk factor for decreased transplant-free survival (P = .003; hazard ratio, 4.29), which was unchanged when adjusted for all covariates.
  
  
  CONCLUSIONS
  The need for early fundoplication or gastrostomy is associated with decreased transplant-free survival for patients with palliated single-ventricle heart disease.
authors.affiliation: Division of Cardiothoracic Surgery, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Jane J
authors.initials: JJ
authors.lastname: Keating
authors.forename: Janet M
authors.initials: JM
authors.lastname: Simsic
authors.forename: Brian E
authors.initials: BE
authors.lastname: Kogon
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Kanter
authors.forename: Jeryl
authors.initials: J
authors.lastname: Huckaby
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Kilgo
authors.forename: Paul M
authors.initials: PM
authors.lastname: Kirshbom
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication / Q000009:adverse effects* / Q000401:mortality; D005774:Gastrostomy / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D005845:Georgia; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D010166:Palliative Care; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome