title: Factors affecting Fontan length of stay: Results from the Single Ventricle Reconstruction trial.
abstract: BACKGROUND
  In the Single Ventricle Reconstruction trial, infants with hypoplastic left heart syndrome (HLHS) who received a right-ventricle-to-pulmonary-artery shunt (RVPAS) versus a modified Blalock-Taussig shunt (MBTS) had lower early postoperative mortality, but more complications at 14 months. We explored the effect of shunt type and other patient, medical, and surgical factors on postoperative length of stay (LOS) after the Fontan operation.
  
  
  METHODS
  Fontan postoperative course was ascertained from medical record review. Cox proportional hazards modeling was used to identify factors associated with LOS.
  
  
  RESULTS
  Of 327 subjects who underwent Fontan, 323 were analyzed (1 death, 1 biventricular repair, 2 with missing data). Median age and weight at Fontan were 2.8 years (interquartile range [IQR]: 2.3, 3.4) and 12.7 kg (IQR: 11.4, 14.1), respectively. Fontan type was extracardiac in 55% and lateral tunnel in 45%; 87% were fenestrated. The RVPAS and MBTS subjects had similar LOS (median 11 days [IQR: 9, 18] vs 10 days [IQR: 9, 13]; P = .23). Independent risk factors for longer LOS were treatment center (P < .01), LOS at stage II (hazard ratio [HR] 1.02 for each additional day; P < .01), and pre-Fontan complications (HR 1.03 for each additional complication; P = .04). Use of deep hypothermic circulatory arrest at Fontan (HR 0.64; P = .02) was independently associated with shorter LOS. When center was excluded from the model, pre-Fontan complications and use of circulatory arrest were no longer significant; instead, older age at stage II (HR 1.08 for each additional month; P = .01) predicted longer LOS. In 254 subjects who had a pre-Fontan echocardiogram, at least moderate tricuspid regurgitation was independently associated with longer LOS, both with center (HR 1.72; P < .01) and without center in the model (HR 1.49; P = .02).
  
  
  CONCLUSIONS
  In this multicenter prospective cohort of subjects with HLHS, Norwood shunt type was not associated with Fontan LOS. Rather, global measures of earlier medical complexity indicate greater likelihood of longer LOS after the Fontan operation.
authors.affiliation: Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa. Electronic address: ravishankar@email.chop.edu.
authors.forename: Chitra
authors.initials: C
authors.lastname: Ravishankar
authors.affiliation: New England Research Institute, Watertown, Mass.
authors.forename: Eric
authors.initials: E
authors.lastname: Gerstenberger
authors.affiliation: New England Research Institute, Watertown, Mass.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Sleeper
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Atz
authors.affiliation: Department of Critical Care Medicine, The Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: Jeremy T
authors.initials: JT
authors.lastname: Affolter
authors.affiliation: Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Bradley
authors.affiliation: Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Bryan H
authors.initials: BH
authors.lastname: Goldstein
authors.affiliation: Department of Pediatrics, Duke Medical Center, Durham, NC.
authors.forename: Heather T
authors.initials: HT
authors.lastname: Henderson
authors.affiliation: Division of Cardiothoracic Surgery, Congenital Heart Institute of Florida, St Petersburg, Fla.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif.
authors.forename: Alan B
authors.initials: AB
authors.lastname: Lewis
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Mass.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Dunbar-Masterson
authors.affiliation: University of Utah, Department of Pediatrics, Salt Lake City, Utah.
authors.forename: Shaji C
authors.initials: SC
authors.lastname: Menon
authors.affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Pemberton
authors.affiliation: Department of Pediatrics, Sibley Heart Center, Atlanta, Ga.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Petit
authors.affiliation: Department of Nursing, University of California, Los Angeles, Los Angeles, Calif.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Pike
authors.affiliation: Division of Cardiothoracic Surgery, Alfred I. DuPont Hospital for Children, Wilmington, Del.
authors.forename: Christian
authors.initials: C
authors.lastname: Pizarro
authors.affiliation: Department of Pediatrics, University of Michigan Health Center, Ann Arbor, Mich.
authors.forename: Kurt R
authors.initials: KR
authors.lastname: Schumacher
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY.
authors.forename: Ismee A
authors.initials: IA
authors.lastname: Williams
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Mass.
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
mesh_terms: D058366:Blalock-Taussig Procedure / Q000009:adverse effects / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D015999:Multivariate Analysis; D009656:North America; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Fontan; Single Ventricle Reconstruction trial; hypoplastic left heart syndrome