title: Superior cavopulmonary anastomosis timing and outcomes in infants with single ventricle.
abstract: OBJECTIVE
  We sought to identify factors associated with the timing and surgical outcomes of the superior cavopulmonary anastomosis.
  
  
  METHODS
  The Pediatric Heart Network's Infant Single Ventricle trial database identified participants who underwent superior cavopulmonary anastomosis. Factors potentially associated with age at superior cavopulmonary anastomosis, length of stay and death by 14 months of age were evaluated. Factors included subject demographics, cardiac anatomy, measures from neonatal hospitalization and pre-superior cavopulmonary anastomosis visit, adverse events, echocardiographic variables, intraoperative variables, superior cavopulmonary anastomosis type, and number of concurrent cardiac surgical procedures. Age at superior cavopulmonary anastomosis was analyzed using Cox proportional hazards regression. Natural log length of stay was analyzed by multiple linear regression.
  
  
  RESULTS
  Superior cavopulmonary anastomosis was performed in 193 subjects at 5.2 months of age (interquartile range, 4.2, 6.2) and weight of 5.9 kg (interquartile range, 5.3, 6.6). The median length of stay was 7 days (interquartile range, 6, 10). There were 3 deaths and 1 transplant during the superior cavopulmonary anastomosis hospitalization, and 3 deaths and 3 transplants between discharge and 14 months of age. Age at superior cavopulmonary anastomosis was associated with center and interstage adverse events. A longer length of stay was associated with younger age and greater case complexity. Superior cavopulmonary anastomosis type, valve regurgitation, ventricular ejection fraction, and ventricular end-diastolic pressure were not independently associated with age at superior cavopulmonary anastomosis or the length of stay.
  
  
  CONCLUSIONS
  Greater case complexity and more frequent interstage adverse events are associated with an earlier age at superior cavopulmonary anastomosis. Significant variation in age at superior cavopulmonary anastomosis among centers, independent of subject factors, highlights a lack of consensus regarding the optimal timing. Factors associated with length of stay could offer insights for improving presuperior cavopulmonary anastomosis care and surgical outcome.
authors.affiliation: Heart Institute, Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. james.cnota@cchmc.org
authors.forename: James F
authors.initials: JF
authors.lastname: Cnota
authors.forename: Kerstin R
authors.initials: KR
authors.lastname: Allen
authors.forename: Steven
authors.initials: S
authors.lastname: Colan
authors.forename: Wesley
authors.initials: W
authors.lastname: Covitz
authors.forename: Eric M
authors.initials: EM
authors.lastname: Graham
authors.forename: David A
authors.initials: DA
authors.lastname: Hehir
authors.forename: Jami C
authors.initials: JC
authors.lastname: Levine
authors.forename: Renee
authors.initials: R
authors.lastname: Margossian
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: L LuAnn
authors.initials: LL
authors.lastname: Minich
authors.forename: Shobha
authors.initials: S
authors.lastname: Natarajan
authors.forename: Marc E
authors.initials: ME
authors.lastname: Richmond
authors.forename: Daphne T
authors.initials: DT
authors.lastname: Hsu
mesh_terms: D000367:Age Factors; D060666:Airway Extubation; D004311:Double-Blind Method; D018610:Heart Bypass, Right / Q000009:adverse effects / Q000401:mortality; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D015999:Multivariate Analysis; D009656:North America; D018579:Patient Selection; D016016:Proportional Hazards Models; D012086:Reoperation; D012121:Respiration, Artificial; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome