Impact of home monitoring program on interstage mortality after the Norwood procedure
ObjectiveWhile early outcome after the Norwood operation for hypoplastic left heart syndrome has improved, interstage mortality until bidirectional cavopulmonary shunt (BCPS) remains a concern. Our aim was to institute a home monitoring program to (HMP) decrease interstage mortality.MethodsAmong 264...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1239477/full |
| _version_ | 1797661958411911168 |
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| author | Helena Staehler Helena Staehler Thibault Schaeffer Thibault Schaeffer Johanna Wasner Johanna Wasner Julia Lemmer Michel Adam Melchior Burri Alfred Hager Peter Ewert Jürgen Hörer Jürgen Hörer Masamichi Ono Masamichi Ono Paul Philipp Heinisch Paul Philipp Heinisch |
| author_facet | Helena Staehler Helena Staehler Thibault Schaeffer Thibault Schaeffer Johanna Wasner Johanna Wasner Julia Lemmer Michel Adam Melchior Burri Alfred Hager Peter Ewert Jürgen Hörer Jürgen Hörer Masamichi Ono Masamichi Ono Paul Philipp Heinisch Paul Philipp Heinisch |
| author_sort | Helena Staehler |
| collection | DOAJ |
| description | ObjectiveWhile early outcome after the Norwood operation for hypoplastic left heart syndrome has improved, interstage mortality until bidirectional cavopulmonary shunt (BCPS) remains a concern. Our aim was to institute a home monitoring program to (HMP) decrease interstage mortality.MethodsAmong 264 patients who survived Norwood procedure and were discharged before BCPS, 80 patients were included in the HMP and compared to the remaining 184 patients regarding interstage mortality. In patients with HMP, events during the interstage period were evaluated.ResultsInterstage mortality was 8% (n = 21), and was significantly lower in patients with HMP (2.5%, n = 2), compared to those without (10.3%, n = 19, p = 0.031). Patients with interstage mortality had significantly lower birth weight (p < 0.001) compared to those without. Lower birth weight (p < 0.001), extra corporeal membrane oxygenation support (p = 0.002), and lack of HMP (p = 0.048) were risk factors for interstage mortality. Most frequent event during home monitoring was low saturation (<70%) in 14 patients (18%), followed by infection in 6 (7.5%), stagnated weight gain in 5 (6.3%), hypoxic shock in 3 (3.8%) and arrhythmias in 2 (2.5%). An unexpected readmission was needed in 24 patients (30%). In those patients, age (p = 0.001) and weight at BCPS (p = 0.007) were significantly lower compared to those without readmission, but the survival after BCPS was comparable between the groups.ConclusionsInterstage HMP permits timely intervention and led to an important decrease in interstage mortality. One-third of the patients with home monitoring program needed re-admission and demonstrated the need for earlier stage 2 palliation. |
| first_indexed | 2024-03-11T18:53:09Z |
| format | Article |
| id | doaj.art-effde5bb13d54b73bcac312a56f1ead9 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-11T18:53:09Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-effde5bb13d54b73bcac312a56f1ead92023-10-11T07:53:40ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-10-011010.3389/fcvm.2023.12394771239477Impact of home monitoring program on interstage mortality after the Norwood procedureHelena Staehler0Helena Staehler1Thibault Schaeffer2Thibault Schaeffer3Johanna Wasner4Johanna Wasner5Julia Lemmer6Michel Adam7Melchior Burri8Alfred Hager9Peter Ewert10Jürgen Hörer11Jürgen Hörer12Masamichi Ono13Masamichi Ono14Paul Philipp Heinisch15Paul Philipp Heinisch16Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, GermanyDivision of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, GermanyDepartment of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, GermanyDivision of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, GermanyDepartment of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, GermanyDivision of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, GermanyDepartment of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, GermanyDepartment of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, GermanyDepartment of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, GermanyDepartment of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, GermanyDepartment of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, GermanyDepartment of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, GermanyDivision of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, GermanyDepartment of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, GermanyDivision of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, GermanyDepartment of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, GermanyDivision of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, GermanyObjectiveWhile early outcome after the Norwood operation for hypoplastic left heart syndrome has improved, interstage mortality until bidirectional cavopulmonary shunt (BCPS) remains a concern. Our aim was to institute a home monitoring program to (HMP) decrease interstage mortality.MethodsAmong 264 patients who survived Norwood procedure and were discharged before BCPS, 80 patients were included in the HMP and compared to the remaining 184 patients regarding interstage mortality. In patients with HMP, events during the interstage period were evaluated.ResultsInterstage mortality was 8% (n = 21), and was significantly lower in patients with HMP (2.5%, n = 2), compared to those without (10.3%, n = 19, p = 0.031). Patients with interstage mortality had significantly lower birth weight (p < 0.001) compared to those without. Lower birth weight (p < 0.001), extra corporeal membrane oxygenation support (p = 0.002), and lack of HMP (p = 0.048) were risk factors for interstage mortality. Most frequent event during home monitoring was low saturation (<70%) in 14 patients (18%), followed by infection in 6 (7.5%), stagnated weight gain in 5 (6.3%), hypoxic shock in 3 (3.8%) and arrhythmias in 2 (2.5%). An unexpected readmission was needed in 24 patients (30%). In those patients, age (p = 0.001) and weight at BCPS (p = 0.007) were significantly lower compared to those without readmission, but the survival after BCPS was comparable between the groups.ConclusionsInterstage HMP permits timely intervention and led to an important decrease in interstage mortality. One-third of the patients with home monitoring program needed re-admission and demonstrated the need for earlier stage 2 palliation.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1239477/fullhypoplastic left heart syndromeNorwood procedureinterstage home monitoring programbidirectional cavopulmonary shuntBCPS |
| spellingShingle | Helena Staehler Helena Staehler Thibault Schaeffer Thibault Schaeffer Johanna Wasner Johanna Wasner Julia Lemmer Michel Adam Melchior Burri Alfred Hager Peter Ewert Jürgen Hörer Jürgen Hörer Masamichi Ono Masamichi Ono Paul Philipp Heinisch Paul Philipp Heinisch Impact of home monitoring program on interstage mortality after the Norwood procedure Frontiers in Cardiovascular Medicine hypoplastic left heart syndrome Norwood procedure interstage home monitoring program bidirectional cavopulmonary shunt BCPS |
| title | Impact of home monitoring program on interstage mortality after the Norwood procedure |
| title_full | Impact of home monitoring program on interstage mortality after the Norwood procedure |
| title_fullStr | Impact of home monitoring program on interstage mortality after the Norwood procedure |
| title_full_unstemmed | Impact of home monitoring program on interstage mortality after the Norwood procedure |
| title_short | Impact of home monitoring program on interstage mortality after the Norwood procedure |
| title_sort | impact of home monitoring program on interstage mortality after the norwood procedure |
| topic | hypoplastic left heart syndrome Norwood procedure interstage home monitoring program bidirectional cavopulmonary shunt BCPS |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1239477/full |
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