Gastrointestinal complications after stage i Norwood versus hybrid procedures

Ryan R Davies, Stephanie W. Carver, Richard Schmidt, Heather Keskeny, Jeannine Hoch, Christian Pizarro

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Patients undergoing palliation for hypoplastic left heart syndrome are at risk for gastrointestinal complications including necrotizing enterocolitis, gastroesophageal reflux, and intolerance to oral feeding. Few data exist comparing these outcomes between patients undergoing the Norwood and hybrid procedures. Methods: Forty-three patients with hypoplastic left heart syndrome or variants underwent 50 Norwood (n = 34) or hybrid (n = 16) procedures (2004 to 2011). Routine preoperative assessments included flexible fiberoptic laryngoscopy and oral feeding evaluations. Examinations were repeated postoperatively with modified barium swallows. A retrospective review was conducted to examine the incidence, causes, and consequences of gastrointestinal complications. Results: In 18 of 50 cases (38%), patients were tolerating full oral feeding at discharge; abnormal preoperative feeding evaluation predicted the inability to feed orally (p < 0.002, positive predictive value 100%). Hybrid and Norwood patients had a similar incidence of vocal fold palsy (20.0% versus 34.5%, p = 0.3), and inability to feed orally at discharge (67.5% versus 56.3%, p = not significant). Both groups had a high incidence. Postoperative abnormalities were common, namely, abnormal oral feeding evaluations (70.7%) or modified barium swallows (81.8%). Predictors of abnormal postoperative examinations included noncardiac congenital anomalies (p = 0.08), preoperative mechanical ventilation (p = 0.01), and younger age (p = 0.01). Grade IIA/IIB necrotizing enterocolitis was more common among patients having hybrid procedures (26.7%, versus 2.9%, p = 0.01). Conclusions: Gastrointestinal complications are common after initial palliation of patients with hypoplastic left heart syndrome. Preoperative and perioperative factors play a significant role. Despite a more "limited" intervention, patients undergoing hybrid procedures remain at high risk for feeding issues, commonly leading to a prolonged hospital course. Close attention and proactive management are essential to optimize the nutritional status in these patients.

Original languageEnglish (US)
Pages (from-to)189-196
Number of pages8
JournalAnnals of Thoracic Surgery
Volume95
Issue number1
DOIs
StatePublished - Jan 1 2013

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Hypoplastic Left Heart Syndrome
Swallows
Necrotizing Enterocolitis
Barium
Incidence
Norwood Procedures
Vocal Cord Paralysis
Laryngoscopy
Gastroesophageal Reflux
Nutritional Status
Artificial Respiration

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Gastrointestinal complications after stage i Norwood versus hybrid procedures. / Davies, Ryan R; Carver, Stephanie W.; Schmidt, Richard; Keskeny, Heather; Hoch, Jeannine; Pizarro, Christian.

In: Annals of Thoracic Surgery, Vol. 95, No. 1, 01.01.2013, p. 189-196.

Research output: Contribution to journalArticle

Davies, Ryan R ; Carver, Stephanie W. ; Schmidt, Richard ; Keskeny, Heather ; Hoch, Jeannine ; Pizarro, Christian. / Gastrointestinal complications after stage i Norwood versus hybrid procedures. In: Annals of Thoracic Surgery. 2013 ; Vol. 95, No. 1. pp. 189-196.
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abstract = "Background: Patients undergoing palliation for hypoplastic left heart syndrome are at risk for gastrointestinal complications including necrotizing enterocolitis, gastroesophageal reflux, and intolerance to oral feeding. Few data exist comparing these outcomes between patients undergoing the Norwood and hybrid procedures. Methods: Forty-three patients with hypoplastic left heart syndrome or variants underwent 50 Norwood (n = 34) or hybrid (n = 16) procedures (2004 to 2011). Routine preoperative assessments included flexible fiberoptic laryngoscopy and oral feeding evaluations. Examinations were repeated postoperatively with modified barium swallows. A retrospective review was conducted to examine the incidence, causes, and consequences of gastrointestinal complications. Results: In 18 of 50 cases (38{\%}), patients were tolerating full oral feeding at discharge; abnormal preoperative feeding evaluation predicted the inability to feed orally (p < 0.002, positive predictive value 100{\%}). Hybrid and Norwood patients had a similar incidence of vocal fold palsy (20.0{\%} versus 34.5{\%}, p = 0.3), and inability to feed orally at discharge (67.5{\%} versus 56.3{\%}, p = not significant). Both groups had a high incidence. Postoperative abnormalities were common, namely, abnormal oral feeding evaluations (70.7{\%}) or modified barium swallows (81.8{\%}). Predictors of abnormal postoperative examinations included noncardiac congenital anomalies (p = 0.08), preoperative mechanical ventilation (p = 0.01), and younger age (p = 0.01). Grade IIA/IIB necrotizing enterocolitis was more common among patients having hybrid procedures (26.7{\%}, versus 2.9{\%}, p = 0.01). Conclusions: Gastrointestinal complications are common after initial palliation of patients with hypoplastic left heart syndrome. Preoperative and perioperative factors play a significant role. Despite a more {"}limited{"} intervention, patients undergoing hybrid procedures remain at high risk for feeding issues, commonly leading to a prolonged hospital course. Close attention and proactive management are essential to optimize the nutritional status in these patients.",
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AB - Background: Patients undergoing palliation for hypoplastic left heart syndrome are at risk for gastrointestinal complications including necrotizing enterocolitis, gastroesophageal reflux, and intolerance to oral feeding. Few data exist comparing these outcomes between patients undergoing the Norwood and hybrid procedures. Methods: Forty-three patients with hypoplastic left heart syndrome or variants underwent 50 Norwood (n = 34) or hybrid (n = 16) procedures (2004 to 2011). Routine preoperative assessments included flexible fiberoptic laryngoscopy and oral feeding evaluations. Examinations were repeated postoperatively with modified barium swallows. A retrospective review was conducted to examine the incidence, causes, and consequences of gastrointestinal complications. Results: In 18 of 50 cases (38%), patients were tolerating full oral feeding at discharge; abnormal preoperative feeding evaluation predicted the inability to feed orally (p < 0.002, positive predictive value 100%). Hybrid and Norwood patients had a similar incidence of vocal fold palsy (20.0% versus 34.5%, p = 0.3), and inability to feed orally at discharge (67.5% versus 56.3%, p = not significant). Both groups had a high incidence. Postoperative abnormalities were common, namely, abnormal oral feeding evaluations (70.7%) or modified barium swallows (81.8%). Predictors of abnormal postoperative examinations included noncardiac congenital anomalies (p = 0.08), preoperative mechanical ventilation (p = 0.01), and younger age (p = 0.01). Grade IIA/IIB necrotizing enterocolitis was more common among patients having hybrid procedures (26.7%, versus 2.9%, p = 0.01). Conclusions: Gastrointestinal complications are common after initial palliation of patients with hypoplastic left heart syndrome. Preoperative and perioperative factors play a significant role. Despite a more "limited" intervention, patients undergoing hybrid procedures remain at high risk for feeding issues, commonly leading to a prolonged hospital course. Close attention and proactive management are essential to optimize the nutritional status in these patients.

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