Postoperative heart failure after stage 1 palliative surgery for single ventricle cardiac disease.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: Springer Verlag Country of Publication: United States NLM ID: 8003849 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1971 (Electronic) Linking ISSN: 01720643 NLM ISO Abbreviation: Pediatr Cardiol Subsets: MEDLINE
    • Publication Information:
      Publication: New York Ny : Springer Verlag
      Original Publication: [New York, Springer-Verlag]
    • Subject Terms:
      Cardiac Surgical Procedures/*adverse effects ; Heart Defects, Congenital/*surgery ; Heart Failure/*etiology ; Postoperative Complications/*etiology ; Ventricular Dysfunction/*surgery; Female ; Heart Failure/mortality ; Humans ; Infant ; Male ; Palliative Care ; Postoperative Complications/mortality ; Postoperative Period ; Retrospective Studies ; Risk Factors ; Ventricular Dysfunction/congenital
    • Abstract:
      Outcomes for patients with single ventricle congenital heart disease (SV-CHD) continue to improve over time. However, the prognosis for patients who develop heart failure immediately after surgery is poorly understood. We conducted a single-center, retrospective cohort study of patients with SV-CHD, who suffered postoperative heart failure. Of 1038 cardiac surgeries performed on 621 SV-CHD patients between 2004 and 2010, 125 patients met inclusion criteria, including non-septatable anatomy, stage 1 surgery, and verified low cardiac output or heart failure state per STS definition. Overall survival was 73.2% at 2 months, 64.9% at 1 year, 60.5% at 2 years, and 54.6% at 4 years. Inotrope dependence beyond 7 days post-op yielded 45% 2-year survival versus 68% for those who weaned from inotropes within 7 days (p = 0.02). Atrioventricular valve regurgitation (AVVR) influenced survival, and patients who developed renal failure or required ECMO fared poorly, even when they survived their hospitalization. Patients with postoperative heart failure and low cardiac output syndrome constitute a high-risk population beyond the term of the initial hospitalization and have an overall mid-term survival of 55% at 4 years. Wean from inotropic therapy is not completely reassuring in this population, as they have ongoing elevated risk of cardiac failure and death in the medium term. Ventricular dysfunction, AVVR, renal failure, and need for ECMO are all important prognostic factors for mid-term mortality. Inotrope dependence for > 7 days has important implications reaching beyond the hospitalization.
    • References:
      Ann Thorac Surg. 2001 Jul;72(1):182-6. (PMID: 11465175)
      Ann Thorac Surg. 2001 Oct;72(4):1349-53. (PMID: 11603459)
      J Thorac Cardiovasc Surg. 1992 Jul;104(1):189-94; discussion 194-5. (PMID: 1377313)
      J Thorac Cardiovasc Surg. 2003 Nov;126(5):1367-77. (PMID: 14666008)
      J Heart Lung Transplant. 1992 Mar-Apr;11(2 Pt 1):311-9. (PMID: 1576137)
      J Thorac Cardiovasc Surg. 2006 Jan;131(1):172-80. (PMID: 16399309)
      Pediatr Cardiol. 2007 Nov-Dec;28(6):426-32. (PMID: 17676374)
      Circulation. 2007 Sep 11;116(11 Suppl):I157-64. (PMID: 17846297)
      Circulation. 2008 Jan 1;117(1):85-92. (PMID: 18071068)
      Ann Thorac Surg. 2009 Aug;88(2):558-63; discussion 563-4. (PMID: 19632412)
      N Engl J Med. 2010 May 27;362(21):1980-92. (PMID: 20505177)
      J Thorac Cardiovasc Surg. 2010 Jul;140(1):129-36. (PMID: 20620378)
      J Am Coll Cardiol. 2010 Sep 28;56(14):1149-57. (PMID: 20863956)
      J Thorac Cardiovasc Surg. 2011 Oct;142(4):855-60. (PMID: 21397261)
      Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2011;14(1):75-84. (PMID: 21444052)
      Ann Thorac Surg. 2011 Aug;92(2):642-51; discussion 651-2. (PMID: 21550583)
      J Thorac Cardiovasc Surg. 2011 Aug;142(2):326-35.e2. (PMID: 21592529)
      J Thorac Cardiovasc Surg. 2011 Dec;142(6):1358-66. (PMID: 21703635)
      J Am Coll Cardiol. 2012 Jan 3;59(1 Suppl):S1-42. (PMID: 22192720)
      J Am Coll Surg. 2013 Apr;216(4):699-704; discussion 704-6. (PMID: 23415555)
      Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2013;16(1):3-6. (PMID: 23561811)
      Pediatr Cardiol. 2016 Feb;37(2):239-47. (PMID: 26396116)
      J Heart Lung Transplant. 2018 Jul;37(7):879-885. (PMID: 29571602)
      Ann Thorac Surg. 1993 Dec;56(6):1239-47. (PMID: 8267419)
      Ann Surg. 1996 Sep;224(3):387-94; discussion 394-5. (PMID: 8813267)
      J Thorac Cardiovasc Surg. 1997 Feb;113(2):262-8; discussion 269. (PMID: 9040619)
    • Contributed Indexing:
      Keywords: Congenital heart disease; Heart failure; Hypoplastic left heart syndrome; Infants; Pediatric critical care; Postoperative outcomes
    • Publication Date:
      Date Created: 20190403 Date Completed: 20190718 Latest Revision: 20200225
    • Publication Date:
      20240829
    • Accession Number:
      10.1007/s00246-019-02093-4
    • Accession Number:
      30937501