Ten-year institutional experience with palliative surgery for hypoplastic left heart syndrome: Risk factors related to stage I mortality

J. M. Forbess, N. Cook, S. J. Roth, A. Serraf, J. E. Mayer, R. A. Jonas

Research output: Contribution to journalArticle

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Abstract

Background: We reviewed 212 consecutive patients who underwent stage I palliative surgery for hypoplastic left heart syndrome (HLHS) at our institution between January 1983 and June 1993. Methods and Results: Six surgeons participated in the care of these patients. Follow-up is 97% complete. Preoperative anatomic and physiological factors and procedural features of the stage I operation were analyzed for impact on stage I mortality, survival to stage II palliation, and actuarial survival. Hospital mortality was not significantly lower during the second half of the study period (P=.242). Operative mortality was 46.2%. Multivariate analysis revealed improved stage I operative survival in patients with mitral stenosis (MS) and aortic stenosis (AS; P=.006). Additional risk factors for stage I mortality were a lower immediately pre-stage I pH (P=.034) and weight <.3 kg (P=.015). Overall first-year actuarial survival for MS/AS was 59%, and it was 33% for all others (P=.001). Among stage I survivors, patients with MS/AS were more likely to survive to stage II palliation (P=.031). Analysis of actuarial survival of stage I survivors showed that a smaller ascending aorta (P<.001), aortic atresia (P<.001), and mitral atresia (P=.002) were all risk factors for intermediate death. Conclusions: Preoperative anatomic and physiological state are predictors of stage I mortality. HLHS anatomic subtype also influences intermediate outcome, most notably pre-stage II attrition. These data may be useful in choosing initial management for patients with HLHS.

Original languageEnglish (US)
JournalCirculation
Volume92
Issue number9 SUPPL.
StatePublished - 1995

Fingerprint

Hypoplastic Left Heart Syndrome
Palliative Care
Mitral Valve Stenosis
Survival
Mortality
Survivors
Actuarial Analysis
Aortic Valve Stenosis
Survival Analysis
Hospital Mortality
Aorta
Patient Care
Multivariate Analysis
Weights and Measures

Keywords

  • hypoplastic left heart syndrome
  • mortality
  • surgery
  • survival

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Ten-year institutional experience with palliative surgery for hypoplastic left heart syndrome : Risk factors related to stage I mortality. / Forbess, J. M.; Cook, N.; Roth, S. J.; Serraf, A.; Mayer, J. E.; Jonas, R. A.

In: Circulation, Vol. 92, No. 9 SUPPL., 1995.

Research output: Contribution to journalArticle

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abstract = "Background: We reviewed 212 consecutive patients who underwent stage I palliative surgery for hypoplastic left heart syndrome (HLHS) at our institution between January 1983 and June 1993. Methods and Results: Six surgeons participated in the care of these patients. Follow-up is 97{\%} complete. Preoperative anatomic and physiological factors and procedural features of the stage I operation were analyzed for impact on stage I mortality, survival to stage II palliation, and actuarial survival. Hospital mortality was not significantly lower during the second half of the study period (P=.242). Operative mortality was 46.2{\%}. Multivariate analysis revealed improved stage I operative survival in patients with mitral stenosis (MS) and aortic stenosis (AS; P=.006). Additional risk factors for stage I mortality were a lower immediately pre-stage I pH (P=.034) and weight <.3 kg (P=.015). Overall first-year actuarial survival for MS/AS was 59{\%}, and it was 33{\%} for all others (P=.001). Among stage I survivors, patients with MS/AS were more likely to survive to stage II palliation (P=.031). Analysis of actuarial survival of stage I survivors showed that a smaller ascending aorta (P<.001), aortic atresia (P<.001), and mitral atresia (P=.002) were all risk factors for intermediate death. Conclusions: Preoperative anatomic and physiological state are predictors of stage I mortality. HLHS anatomic subtype also influences intermediate outcome, most notably pre-stage II attrition. These data may be useful in choosing initial management for patients with HLHS.",
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