Association of Interstage Monitoring Era and Likelihood of Hemodynamic Compromise at Intervention for Recoarctation Following the Norwood Operation
Background Intensive monitoring has been associated with a lower death rate between the Norwood operation and superior cavopulmonary connection, possibly due to early identification and effective treatment of residual anatomic lesions like recoarctation before lasting harm occurs. Methods and Result...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.029112 |
| _version_ | 1797742597863636992 |
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| author | Ari J. Gartenberg Oluwatimilehin Okunowo Yoav Dori Christopher L. Smith J. William Gaynor Christopher E. Mascio Jonathan J. Rome Matthew J. Gillespie Andrew C. Glatz Michael L. O'Byrne |
| author_facet | Ari J. Gartenberg Oluwatimilehin Okunowo Yoav Dori Christopher L. Smith J. William Gaynor Christopher E. Mascio Jonathan J. Rome Matthew J. Gillespie Andrew C. Glatz Michael L. O'Byrne |
| author_sort | Ari J. Gartenberg |
| collection | DOAJ |
| description | Background Intensive monitoring has been associated with a lower death rate between the Norwood operation and superior cavopulmonary connection, possibly due to early identification and effective treatment of residual anatomic lesions like recoarctation before lasting harm occurs. Methods and Results Neonates undergoing a Norwood operation and receiving interstage care at a single center between January 1, 2005, and September 18, 2020, were studied. In those with recoarctation, we evaluated association of era ([1] preinterstage monitoring, [2] a transitional phase, [3] current era) and likelihood of hemodynamic compromise (progression to moderate or greater ventricular dysfunction/atrioventricular valve regurgitation, initiation/escalation of vasoactive/respiratory support, cardiac arrest preceding catheterization, or interstage death with recoarctation on autopsy). We also analyzed whether era was associated with technical success of transcatheter recoarctation interventions, major adverse events, and transplant‐free survival. A total of 483 subjects were studied, with 22% (n=106) treated for recoarctation during the interstage period. Number of catheterizations per Norwood increased (P=0.005) over the interstage eras, with no significant change in the proportion of subjects with recoarctation (P=0.36). In parallel, there was a lower likelihood of hemodynamic compromise in subjects with recoarctation that was not statistically significant (P=0.06), with a significant difference in the proportion with ventricular dysfunction at intervention (P=0.002). Rates of technical success, procedural major adverse events, and transplant‐free survival did not differ (P>0.05). Conclusions Periods with interstage monitoring were associated with increased referral for catheterization but also reduced likelihood of ventricular dysfunction (and a suggestion of lower likelihood of hemodynamic compromise) in subjects with recoarctation. Further study is needed to guide optimal interstage care of this vulnerable population. |
| first_indexed | 2024-03-12T14:42:59Z |
| format | Article |
| id | doaj.art-644e116452bc4d5da0c88c1c751ee295 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-12T14:42:59Z |
| publishDate | 2023-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-644e116452bc4d5da0c88c1c751ee2952023-08-16T04:54:43ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-07-01121410.1161/JAHA.122.029112Association of Interstage Monitoring Era and Likelihood of Hemodynamic Compromise at Intervention for Recoarctation Following the Norwood OperationAri J. Gartenberg0Oluwatimilehin Okunowo1Yoav Dori2Christopher L. Smith3J. William Gaynor4Christopher E. Mascio5Jonathan J. Rome6Matthew J. Gillespie7Andrew C. Glatz8Michael L. O'Byrne9Division of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at the University of Pennsylvania Philadelphia PADepartment of Biomedical and Health Informatics, Data Science and Biostatistics Unit The Children’s Hospital of Philadelphia Philadelphia PADivision of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at the University of Pennsylvania Philadelphia PADivision of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at the University of Pennsylvania Philadelphia PADivision of Cardiothoracic Surgery The Children’s Hospital of Philadelphia and Department of Surgery Perelman School of Medicine at the University of Pennsylvania Philadelphia PADivision of Cardiothoracic Surgery Department of Surgery West Virginia University Children’s Hospital West Virginia University Medical School Morgantown WVDivision of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at the University of Pennsylvania Philadelphia PADivision of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at the University of Pennsylvania Philadelphia PADivision of Cardiology St. Louis Children’s Hospital St. Louis MODivision of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at the University of Pennsylvania Philadelphia PABackground Intensive monitoring has been associated with a lower death rate between the Norwood operation and superior cavopulmonary connection, possibly due to early identification and effective treatment of residual anatomic lesions like recoarctation before lasting harm occurs. Methods and Results Neonates undergoing a Norwood operation and receiving interstage care at a single center between January 1, 2005, and September 18, 2020, were studied. In those with recoarctation, we evaluated association of era ([1] preinterstage monitoring, [2] a transitional phase, [3] current era) and likelihood of hemodynamic compromise (progression to moderate or greater ventricular dysfunction/atrioventricular valve regurgitation, initiation/escalation of vasoactive/respiratory support, cardiac arrest preceding catheterization, or interstage death with recoarctation on autopsy). We also analyzed whether era was associated with technical success of transcatheter recoarctation interventions, major adverse events, and transplant‐free survival. A total of 483 subjects were studied, with 22% (n=106) treated for recoarctation during the interstage period. Number of catheterizations per Norwood increased (P=0.005) over the interstage eras, with no significant change in the proportion of subjects with recoarctation (P=0.36). In parallel, there was a lower likelihood of hemodynamic compromise in subjects with recoarctation that was not statistically significant (P=0.06), with a significant difference in the proportion with ventricular dysfunction at intervention (P=0.002). Rates of technical success, procedural major adverse events, and transplant‐free survival did not differ (P>0.05). Conclusions Periods with interstage monitoring were associated with increased referral for catheterization but also reduced likelihood of ventricular dysfunction (and a suggestion of lower likelihood of hemodynamic compromise) in subjects with recoarctation. Further study is needed to guide optimal interstage care of this vulnerable population.https://www.ahajournals.org/doi/10.1161/JAHA.122.029112aortic recoarctationcongenital heart diseasehypoplastic left heart syndromeinterventional cardiologysingle ventricle |
| spellingShingle | Ari J. Gartenberg Oluwatimilehin Okunowo Yoav Dori Christopher L. Smith J. William Gaynor Christopher E. Mascio Jonathan J. Rome Matthew J. Gillespie Andrew C. Glatz Michael L. O'Byrne Association of Interstage Monitoring Era and Likelihood of Hemodynamic Compromise at Intervention for Recoarctation Following the Norwood Operation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic recoarctation congenital heart disease hypoplastic left heart syndrome interventional cardiology single ventricle |
| title | Association of Interstage Monitoring Era and Likelihood of Hemodynamic Compromise at Intervention for Recoarctation Following the Norwood Operation |
| title_full | Association of Interstage Monitoring Era and Likelihood of Hemodynamic Compromise at Intervention for Recoarctation Following the Norwood Operation |
| title_fullStr | Association of Interstage Monitoring Era and Likelihood of Hemodynamic Compromise at Intervention for Recoarctation Following the Norwood Operation |
| title_full_unstemmed | Association of Interstage Monitoring Era and Likelihood of Hemodynamic Compromise at Intervention for Recoarctation Following the Norwood Operation |
| title_short | Association of Interstage Monitoring Era and Likelihood of Hemodynamic Compromise at Intervention for Recoarctation Following the Norwood Operation |
| title_sort | association of interstage monitoring era and likelihood of hemodynamic compromise at intervention for recoarctation following the norwood operation |
| topic | aortic recoarctation congenital heart disease hypoplastic left heart syndrome interventional cardiology single ventricle |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.029112 |
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