title: Impact of preoperative risk factors on outcomes after Norwood palliation for hypoplastic left heart syndrome.
abstract: BACKGROUND
  Infants with hypoplastic left heart syndrome (HLHS) are susceptible to pre-Norwood comorbidities (PCs) and complications. This study aimed to describe the effect of PCs on timing and survival of Norwood palliation (NP).
  
  
  METHODS
  A single-center, retrospective review of infants with HLHS who underwent initial NP between 2003 and 2010 was performed. PCs included intact atrial septum, ≥ moderate atrioventricular regurgitation (AVVR), no antenatal diagnosis, mitral stenosis/aortic atresia subtype, genetic abnormality, and prematurity. Complications included pre-NP mechanical ventilation, inotropic support, infection, arrhythmia, and end-organ injury. The primary outcome measure was survival after NP.
  
  
  RESULTS
  113 patients were included with 78 (69%) patients having at least one PC and 61 (78%) of those patients having at least one complication. Patients with PCs underwent NP later than those without PCs (7 vs 6 days, P = .036) as well as when associated with a complication (8 vs 5 days, P < .001). Patients with PCs had similar post-Norwood hospital length of stay (P = .116) except when the PC occurred in conjunction with a complication (28 vs 21 days; P = .015). In-hospital mortality post-NP was 10% and interstage mortality was 15%. On multivariable analysis, ≥ moderate AVVR was associated with increased overall mortality (OR 2.8, 95% CI 1.3-6.2). Age at NP was not associated with mortality (P = .638).
  
  
  CONCLUSIONS
  Although PCs are common in infants with HLHS, only ≥ moderate AVVR was associated with increased mortality in this single-center experience. Older age at NP was not a significant risk factor for interstage mortality.
authors.affiliation: Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex. Electronic address: pirouzshamszad@gmail.com.
authors.forename: Pirouz
authors.initials: P
authors.lastname: Shamszad
authors.affiliation: Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
authors.forename: Tal A
authors.initials: TA
authors.lastname: Gospin
authors.affiliation: Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
authors.forename: Borah J
authors.initials: BJ
authors.lastname: Hong
authors.affiliation: Division Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
authors.forename: Emmett D
authors.initials: ED
authors.lastname: McKenzie
authors.affiliation: Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Petit
mesh_terms: D000367:Age Factors; D001022:Aortic Valve Insufficiency / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery*; D007226:Infant Mortality; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D058327:Norwood Procedures / Q000009:adverse effects* / Q000401:mortality; D016017:Odds Ratio; D010166:Palliative Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome