Author + information
- Humera Ahmed,
- Jeffrey Anderson,
- Katherine Bates,
- Craig Fleishman,
- Shobha Natarajan,
- Nancy Ghanayem,
- Carole Lannon and
- David Brown
Interstage mortality (IM) remains high for patients with single-ventricle congenital heart disease (SVCHD) in the period between Stage 1 Palliation (S1P) and Glenn operation. We sought to characterize IM.
This was a descriptive analysis of 2184 patients with SVCHD discharged home after S1P from 60 National Pediatric Cardiology Quality Improvement Collaborative sites between 2008-2015. Patients underwent right ventricle-pulmonary artery conduit (RVPAC), modified Blalock-Taussig shunt (mBTs), or Hybrid; transplants were excluded.
IM occurred in 148 (7%) patients (median gestational age 38 weeks, 54% male, 77% white), at 82 ± 50 days of life, and 105 ± 50 days after hospital discharge; 26 (18%) occurred <30 days after S1P. The mortality rate for RVPAC was lower (5%; 61/1138) than BTs (9%; 65/712) and Hybrid (20%; 27/134) (Figure 1A). More than half of deaths occurred at home (20%) or in the ER (33%). The remainder occurred while inpatient at center of S1P (CICU 37%, ward 4%) or at a different center (5%). Fussiness and breathing problems were most often cited as harbingers of death; distance to surgical center was the biggest barrier to seeking care. Cause of death was unknown in 70/148 (47%) cases; autopsies were performed in 55 (37%) cases (Figure 1B).
Most IM occurred suddenly in the outpatient setting, with non-specific preceding symptoms and unknown cause of death. These data indicate the need for research to identify occult causes of death, i.e. arrhythmia.
Poster Hall, Hall A/B
Monday, March 12, 2018, 9:45 a.m.-10:30 a.m.
Session Title: Predicting Risk in the Perioperative Period
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1297-370
- 2018 American College of Cardiology Foundation