title: Risk factors for profuse systemic-to-pulmonary artery collateral burden in hypoplastic left heart syndrome.
abstract: Risk factors for developing systemic-to-pulmonary artery collaterals (SPCs) in hypoplastic left heart syndrome (HLHS) are unknown. We performed a retrospective case-control study to identify risk factors for developing a profuse SPC burden in HLHS. Angiograms of 439 patients with HLHS (performed <2 years of age) were reviewed using a previously published angiographic grading scale to identify cases (profuse SPC burden, n = 20) and controls (no or minimal SPC burden, n = 35). In univariate analyses, profuse SPC burden was associated with mitral atresia and aortic atresia subtype (MA/AA) (65% vs 14%, p <0.0001), use of a Sano shunt (70% vs 37%, p = 0.03), longer log-transformed durations of intensive care unit stay (p = 0.02), hospital stay (p = 0.002), pleural drainage (p = 0.008) after stage 1 palliation, lower oxygen saturation at discharge after stage 1 palliation (82 ± 4 vs 85 ± 4%, p = 0.03), and a history of severe shunt obstruction (37% vs 11%, p = 0.04). In a multivariate logistic regression model, profuse SPC burden was associated with MA/AA subtype (odds ratio 6.6), Sano shunt type (odds ratio 8.6), and log-transformed duration of hospital stay after stage 1 (odds ratio 7.9, model p <0.0001, area under the curve 0.88). Nonassociated parameters included fetal aortic valve dilation, severe cyanotic episodes, number of days with open sternum or number of additional exploratory thoracotomies after stage 1 palliation, pulmonary vein stenosis, and restrictive atrial septal defect. In conclusion, in the present case-control study of patients with HLHS, the development of a profuse SPC burden was associated with MA/AA subtype, Sano shunt type, and longer duration of hospital stay after stage 1 palliation.
authors: Department of Cardiology, Boston Children's Hospital, Boston, MA, USA. ashwin.prakash@cardio.chboston.org
authors: Ashwin
authors: A
authors: Prakash
authors: Elif
authors: E
authors: Satiroglu
authors: Diego
authors: D
authors: Porras
authors: Doff B
authors: DB
authors: McElhinney
authors: John F
authors: JF
authors: Keane
authors: James E
authors: JE
authors: Lock
authors: Tal
authors: T
authors: Geva
authors: Wilson
authors: W
authors: King
authors: Andrew J
authors: AJ
authors: Powell
mesh_terms: D000792:Angiography; D006328:Cardiac Catheterization; D016022:Case-Control Studies; D002675:Child, Preschool; D003097:Collateral Circulation / Q000502:physiology*; D005260:Female; D018729:Fontan Procedure; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010166:Palliative Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate