Current Practices in the Timing of Stage 2 Palliation.
Mortality through single-ventricle palliation remains high and the effect of the timing of stage 2 palliation (S2P) is not well understood. We investigated current practice patterns in the timing of S2P across two professional societies and compared them to actual practice patterns from two databases of patients who underwent S2P.



A ten-question survey was distributed to the members of the Congenital Heart Surgeons' Society (CHSS) and the European Congenital Heart Surgeons' Association (ECHSA). Results were summarized using descriptive statistics. Surgeon-reported preferences were compared to clinical data from the CHSS Critical Left Ventricular Outflow Tract Obstruction (LVOTO) Registry and the Pediatric Heart Network Single Ventricle Reconstruction (SVR) database.



Overall, 38% (88 of 232) of surgeons from 74 institutions responded, of which 70% (62 of 88) were CHSS members and 30% (26 of 88) were ECHSA members. Surgeons reported performing S2P at a median of five months after stage 1 (interquartile range [IQR]: 4.5-6), with no difference between CHSS and ECHSA surgeons. Surgeons reported performing nonelective S2P at a median of 4.5 months after stage 1 (IQR: 3.5-5.5), again with no difference by society. No difference existed between the surgeon-reported preferences and patient data in the Critical LVOTO and SVR databases for the timing of elective (5 vs 5.1 vs 5.3 months, P = .19) or nonelective S2P (4.5 vs 4.6 vs 4.2 months, P = .06).



There was a remarkable lack of variation in surgeon preferences regarding the timing of S2P. This may represent a natural standardization of practice across congenital heart surgery, which is notable, given the current lack of guidelines regarding the timing of S2P.
1 John W. Kirklin/David Ashburn Fellow, Congenital Heart Surgeons' Society Data Center, The Hospital for Sick Children, Toronto, Ontario, Canada.
James M
JM
Meza
2 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Robert D B
RD
Jaquiss
3 Division of Cardiology, Department of Pediatrics, Morgan-Stanley Children's Hospital/New York Presbyterian Hospital, New York, NY, USA.
Brett R
BR
Anderson
4 Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Michael-Alice
MA
Moga
5 Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
James K
JK
Kirklin
6 Department of Pediatric Heart Surgery, IASO Children's Hospital, Athens, Greece.
George
G
Sarris
7 Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
William G
WG
Williams
8 Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Brian W
BW
McCrindle
D006348:Cardiac Surgical Procedures / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000379:methods*; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome
cavopulmonary anastamosis; congenital heart surgery; database; hypoplastic left heart syndrome