Risk factors for hospital morbidity and mortality after the Norwood procedure: A report from the Pediatric Heart Network Single Ventricle Reconstruction trial.
OBJECTIVE
We sought to identify risk factors for mortality and morbidity during the Norwood hospitalization in newborn infants with hypoplastic left heart syndrome and other single right ventricle anomalies enrolled in the Single Ventricle Reconstruction trial.


METHODS
Potential predictors for outcome included patient- and procedure-related variables and center volume and surgeon volume. Outcome variables occurring during the Norwood procedure and before hospital discharge or stage II procedure included mortality, end-organ complications, length of ventilation, and hospital length of stay. Univariate and multivariable Cox regression analyses were performed with bootstrapping to estimate reliability for mortality.


RESULTS
Analysis included 549 subjects prospectively enrolled from 15 centers; 30-day and hospital mortality were 11.5% (63/549) and 16.0% (88/549), respectively. Independent risk factors for both 30-day and hospital mortality included lower birth weight, genetic abnormality, extracorporeal membrane oxygenation (ECMO) and open sternum on the day of the Norwood procedure. In addition, longer duration of deep hypothermic circulatory arrest was a risk factor for 30-day mortality. Shunt type at the end of the Norwood procedure was not a significant risk factor for 30-day or hospital mortality. Independent risk factors for postoperative renal failure (n = 46), sepsis (n = 93), increased length of ventilation, and hospital length of stay among survivors included genetic abnormality, lower center/surgeon volume, open sternum, and post-Norwood operations.


CONCLUSIONS
Innate patient factors, ECMO, open sternum, and lower center/surgeon volume are important risk factors for postoperative mortality and/or morbidity during the Norwood hospitalization.
Children's Hospital of Philadelphia, Philadelphia, PA, USA. tabbutts@peds.ucsf.edu
Sarah
S
Tabbutt
Nancy
N
Ghanayem
Chitra
C
Ravishankar
Lynn A
LA
Sleeper
David S
DS
Cooper
Deborah U
DU
Frank
Minmin
M
Lu
Christian
C
Pizarro
Peter
P
Frommelt
Caren S
CS
Goldberg
Eric M
EM
Graham
Catherine Dent
CD
Krawczeski
Wyman W
WW
Lai
Alan
A
Lewis
Joel A
JA
Kirsh
Lynn
L
Mahony
Richard G
RG
Ohye
Janet
J
Simsic
Andrew J
AJ
Lodge
Ellen
E
Spurrier
Mario
M
Stylianou
Peter
P
Laussen
D058366:Blalock-Taussig Procedure / Q000009:adverse effects* / Q000401:mortality; D018572:Disease-Free Survival; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007226:Infant Mortality; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D015999:Multivariate Analysis; D009656:North America; D058327:Norwood Procedures / Q000009:adverse effects* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016276:Ventricular Function