Heart failure after the Norwood procedure: An analysis of the Single Ventricle Reconstruction Trial

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:37

Article

Mahle, William T.^1,2  Hu, Chenwei³  Trachtenberg, Felicia³  Menteer, JonDavid^4,5  Kindel, Steven J.^6,7  Dipchand, Anne I.^8,9  Richmond, Marc E.^10,11  Daly, Kevin P.^12,13  Henderson, Heather T.^14,15  Lin, Kimberly Y.^16,17  McCulloch, Michael^18,19  Lal, Ashwin K.^20,21  Schumacher, Kurt R.^22,23  Jacobs, Jeffrey P.^24,25  Atz, Andrew M.²⁶  Villa, Chet R.^27,28  Burns, Kristin M.²⁹  Newburger, Jane W.^12,13 

[1] Emory Univ, Sch Med, Childrens Healthcare Atlanta, 1405 Clifton Rd NE, Atlanta, GA 30322 USA

[2] Emory Univ, Dept Pediat, Div Cardiol, Atlanta, GA 30322 USA

[3] New England Res Inst, Watertown, MA USA

[4] Univ Southern Calif, Childrens Hosp Los Angeles, Los Angeles, CA USA

[5] Univ Southern Calif, Div Cardiol, Dept Pediat, Los Angeles, CA USA

[6] Childrens Hosp Wisconsin, Milwaukee, WI 53201 USA

[7] Univ Wisconsin, Div Cardiol, Dept Pediat, Milwaukee, WI 53201 USA

[8] Univ Toronto, Hosp Sick Children, Toronto, ON, Canada

[9] Univ Toronto, Div Cardiol, Dept Pediat, Toronto, ON, Canada

[10] Columbia Univ, Med Ctr, Morgan Stanley Childrens Hosp New York Presbyteri, New York, NY USA

[11] Columbia Univ, Dept Pediat, Div Cardiol, New York, NY 10027 USA

[12] Harvard Sch Med, Boston Childrens Hosp, Boston, MA USA

[13] Harvard Sch Med, Dept Pediat Cardiol, Boston, MA USA

[14] Duke Univ, Duke Univ Hosp, Durham, NC USA

[15] Duke Univ, Dept Pediat, Div Cardiol, Durham, NC 27706 USA

[16] Univ Penn, Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[17] Univ Penn, Dept Pediat, Div Cardiol, Philadelphia, PA 19104 USA

[18] Thomas Jefferson Univ, Alfred I DuPont Hosp Children, Wilmington, DE USA

[19] Thomas Jefferson Univ, Div Cardiol, Dept Pediat, Wilmington, DE USA

[20] Univ Utah, Primary Childrens Med Ctr, Salt Lake City, UT USA

[21] Univ Utah, Dept Pediat, Div Cardiol, Salt Lake City, UT USA

[22] Univ Michigan Hlth Syst, Ann Arbor, MI USA

[23] Univ Michigan, Dept Pediat, Div Cardiol, Ann Arbor, MI 48109 USA

[24] Johns Hopkins All Childrens Heart Inst, St Petersburg, FL USA

[25] Dept Surg, Div Cardiothorac Surg, St Petersburg, FL USA

[26] Med Univ South Carolina, Div Cardiol, Dept Pediat, Charleston, SC 29425 USA

[27] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA

[28] Univ Cincinnati, Dept Pediat, Div Cardiol, Cincinnati, OH USA

[29] NHLBI, Bldg 10, Bethesda, MD 20892 USA

关键词: congenital heart defect;    congenital heart disease;    cardiac surgery;    single ventricle;    Norwood procedure;   

DOI  :  10.1016/j.healun.2018.02.009

来源: Elsevier

【 摘 要 】

BACKGROUND: Heart failure results in significant morbidity and mortality in young children with hypoplastic left heart syndrome (HLHS) after the Norwood procedure. METHODS: We studied subjects enrolled in the prospective Single Ventricle Reconstruction (SVR) Trial who survived to hospital discharge after a Norwood operation and were followed up to age 6 years. The primary outcome was heart failure, defined as heart transplant listing after Norwood hospitalization, death attributable to heart failure, or symptomatic heart failure (New York Heart Association [NYHA] Class IV). Multivariate modeling was undertaken using Cox regression methodology to determine variables associated with heart failure. RESULTS: Of the 461 subjects discharged home following a Norwood procedure, 66 (14.3%) met the criteria for heart failure. Among these, 15 died from heart failure, 39 were listed for transplant (22 had a transplant, 12 died after listing, and 5 were alive and not yet transplanted), and 12 had NYHA Class IV heart failure but were never listed. The median age at heart failure identification was 1.28 (interquartile range 0.30 to 4.69) years. Factors associated with early heart failure included post-Norwood lower fractional area change, need for extracorporeal membrane oxygenation, non-Hispanic ethnicity, Norwood perfusion type, and total support time (p < 0.05). CONCLUSIONS: By 6 years of age, heart failure developed in nearly 15% of children after the Norwood procedure. Although transplant listing was common, many patients died from heart failure before receiving a transplant or without being listed. Shunt type did not impact the risk of developing heart failure. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

Free