Language
English
Publication Date
1-1-2023
Journal
The Journal of Thoracic and Cardiovascular Surgery
DOI
10.1016/j.jtcvs.2022.01.056
PMID
35599210
Abstract
Objective: Prematurity, low birth weight, genetic syndromes, extracardiac conditions, and secondary cardiac lesions are considered high-risk conditions associated with mortality after stage 1 palliation. We report the impact of these conditions on outcomes from a prospective multicenter improvement collaborative.
Methods: The National Pediatric Cardiology Quality Improvement Collaborative Phase II registry was queried. Comorbid conditions were categorized and quantified to determine the cumulative burden of high-risk diagnoses on survival to the first birthday. Logistic regression was applied to evaluate factors associated with mortality.
Results: Of the 1421 participants, 40% (575) had at least 1 high-risk condition. The aggregate high-risk group had lower survival to the first birthday compared with standard risk (76.2% vs 88.1%, P < .001). Presence of a single high-risk diagnosis was not associated with reduced survival to the first birthday (odds ratio, 0.71; confidence interval, 0.49-1.02, P = .066). Incremental increases in high-risk diagnoses were associated with reduced survival to first birthday (odds ratio, 0.23; confidence interval, 0.15-0.36, P < .001) for 2 and 0.17 (confidence interval, 0.10-0.30, P < .001) for 3 to 5 high-risk diagnoses. Additional analysis that included prestage 1 palliation characteristics and stage 1 palliation perioperative variables identified multiple high-risk diagnoses, poststage 1 palliation extracorporeal membrane oxygenation support (odds ratio, 0.14; confidence interval, 0.10-0.22, P < .001), and cardiac reoperation (odds ratio, 0.66; confidence interval, 0.45-0.98, P = .037) to be associated with reduced survival odds to the first birthday.
Conclusions: The presence of 1 high-risk diagnostic category was not associated with decreased survival at 1 year. Cumulative diagnoses across multiple high-risk diagnostic categories were associated with decreased odds of survival. Further patient accrual is needed to evaluate the impact of specific comorbid conditions within the broader high-risk categories.
Keywords
Child, Humans, Hypoplastic Left Heart Syndrome, Norwood Procedures, Prospective Studies, Retrospective Studies, Palliative Care, Risk Factors, Treatment Outcome, 1-year survival, Norwood, genetic syndromes, high-risk diagnoses, hybrid palliation, hypoplastic left heart syndrome, low birth weight, prematurity, stage 1 palliation
Published Open-Access
yes
Recommended Citation
Backes, Emily R; Afonso, Natasha S; Guffey, Danielle; et al., "Cumulative Comorbid Conditions Influence Mortality Risk After Staged Palliation for Hypoplastic Left Heart Syndrome and Variants" (2023). Faculty and Staff Publications. 5718.
https://digitalcommons.library.tmc.edu/baylor_docs/5718