Infants less than or equal to 2.5 kg have increased mortality and worse motor neurodevelopmental outcomes at 2 years of age after Norwood–Sano palliationCentral MessagePerspective
Objectives: In infants with single-ventricle congenital heart disease, prematurity and low weight at the time of the Norwood operation are risk factors for mortality. Reports assessing outcomes (including neurodevelopment) post Norwood palliation in infants ≤2.5 kg are limited. Methods: All infants...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-06-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273623000827 |
| _version_ | 1797796161302560768 |
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| author | Konstantin Averin, MD, MSc Lindsay Ryerson, MD Morteza Hajihosseini, MSc, PhD Irina A. Dinu, PhD Darren H. Freed, MD, PhD Gwen Bond, RN, MN Ari R. Joffe, MD De Villiers Jonker, MD Leonora Hendson, MD, MSc Charlene M.T. Robertson, MD Joseph Atallah, MDCM, SM |
| author_facet | Konstantin Averin, MD, MSc Lindsay Ryerson, MD Morteza Hajihosseini, MSc, PhD Irina A. Dinu, PhD Darren H. Freed, MD, PhD Gwen Bond, RN, MN Ari R. Joffe, MD De Villiers Jonker, MD Leonora Hendson, MD, MSc Charlene M.T. Robertson, MD Joseph Atallah, MDCM, SM |
| author_sort | Konstantin Averin, MD, MSc |
| collection | DOAJ |
| description | Objectives: In infants with single-ventricle congenital heart disease, prematurity and low weight at the time of the Norwood operation are risk factors for mortality. Reports assessing outcomes (including neurodevelopment) post Norwood palliation in infants ≤2.5 kg are limited. Methods: All infants who underwent a Norwood–Sano procedure between 2004 and 2019 were identified. Infants ≤2.5 kg at the time of the operation (cases) were matched 3:1 with infants >3.0 kg (comparisons) for year of surgery and cardiac diagnosis. Demographic and perioperative characteristics, survival, and functional and neurodevelopmental outcomes were compared. Results: Twenty-seven cases (mean ± standard deviation: weight 2.2 ± 0.3 kg and age 15.6 ± 14.1 days at surgery) and 81 comparisons (3.5 ± 0.4 kg and age 10.9 ± 7.9 days at surgery) were identified. Post-Norwood, cases had a longer time to lactate ≤2 mmol/L (33.1 ± 27.5 vs 17.9 ± 12.2 hours, P < .001), longer duration of ventilation (30.5 ± 24.5 vs 18.6 ± 17.5 days, P = .005), greater need for dialysis (48.1% vs 19.8%, P = .007), and greater need for extracorporeal membrane oxygenation support (29.6% vs 12.3%, P = .004). Cases had significantly greater postoperative (in-hospital) (25.9% vs 1.2%, P < .001) and 2-year (59.2% vs 11.1%, P < .001) mortality. Neurodevelopmental assessment showed the following for cases versus comparisons, respectively: cognitive delay (18.2% vs 7.9%, P = .272), language delay (18.2% vs 11.1%, P = .505), and motor delay (27.3% vs 14.3%, P = .013). Conclusions: Infants ≤2.5 kg at Norwood–Sano palliation have significantly increased postoperative morbidity and mortality up to 2-year follow-up. Neurodevelopmental motor outcomes were worse in these infants. Additional studies are warranted to assess the outcome of alternative medical and interventional treatment plans in this patient population. |
| first_indexed | 2024-03-13T03:28:54Z |
| format | Article |
| id | doaj.art-faa490da632041a8910f2e4f9fe23f89 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-03-13T03:28:54Z |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-faa490da632041a8910f2e4f9fe23f892023-06-25T04:43:45ZengElsevierJTCVS Open2666-27362023-06-0114417425Infants less than or equal to 2.5 kg have increased mortality and worse motor neurodevelopmental outcomes at 2 years of age after Norwood–Sano palliationCentral MessagePerspectiveKonstantin Averin, MD, MSc0Lindsay Ryerson, MD1Morteza Hajihosseini, MSc, PhD2Irina A. Dinu, PhD3Darren H. Freed, MD, PhD4Gwen Bond, RN, MN5Ari R. Joffe, MD6De Villiers Jonker, MD7Leonora Hendson, MD, MSc8Charlene M.T. Robertson, MD9Joseph Atallah, MDCM, SM10Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, CanadaDivision of Critical Care, Department of Pediatrics, University of Alberta, Edmonton, Alberta, CanadaSchool of Public Health, University of Alberta, Edmonton, Alberta, CanadaSchool of Public Health, University of Alberta, Edmonton, Alberta, CanadaDepartment of Surgery, University of Alberta, Edmonton, Alberta, CanadaGlenrose Rehabilitation Hospital, Edmonton, Alberta, CanadaDivision of Critical Care, Department of Pediatrics, University of Alberta, Edmonton, Alberta, CanadaDepartment of Surgery, University of Alberta, Edmonton, Alberta, CanadaSection of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, CanadaGlenrose Rehabilitation Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, CanadaDivision of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Address for reprints: Joseph Atallah, MDCM, SM, Division of Cardiology, Department of Pediatrics, University of Alberta, 8440-112 St, WMC 4C1.19, Edmonton, Alberta, T6G 2B7, Canada.Objectives: In infants with single-ventricle congenital heart disease, prematurity and low weight at the time of the Norwood operation are risk factors for mortality. Reports assessing outcomes (including neurodevelopment) post Norwood palliation in infants ≤2.5 kg are limited. Methods: All infants who underwent a Norwood–Sano procedure between 2004 and 2019 were identified. Infants ≤2.5 kg at the time of the operation (cases) were matched 3:1 with infants >3.0 kg (comparisons) for year of surgery and cardiac diagnosis. Demographic and perioperative characteristics, survival, and functional and neurodevelopmental outcomes were compared. Results: Twenty-seven cases (mean ± standard deviation: weight 2.2 ± 0.3 kg and age 15.6 ± 14.1 days at surgery) and 81 comparisons (3.5 ± 0.4 kg and age 10.9 ± 7.9 days at surgery) were identified. Post-Norwood, cases had a longer time to lactate ≤2 mmol/L (33.1 ± 27.5 vs 17.9 ± 12.2 hours, P < .001), longer duration of ventilation (30.5 ± 24.5 vs 18.6 ± 17.5 days, P = .005), greater need for dialysis (48.1% vs 19.8%, P = .007), and greater need for extracorporeal membrane oxygenation support (29.6% vs 12.3%, P = .004). Cases had significantly greater postoperative (in-hospital) (25.9% vs 1.2%, P < .001) and 2-year (59.2% vs 11.1%, P < .001) mortality. Neurodevelopmental assessment showed the following for cases versus comparisons, respectively: cognitive delay (18.2% vs 7.9%, P = .272), language delay (18.2% vs 11.1%, P = .505), and motor delay (27.3% vs 14.3%, P = .013). Conclusions: Infants ≤2.5 kg at Norwood–Sano palliation have significantly increased postoperative morbidity and mortality up to 2-year follow-up. Neurodevelopmental motor outcomes were worse in these infants. Additional studies are warranted to assess the outcome of alternative medical and interventional treatment plans in this patient population.http://www.sciencedirect.com/science/article/pii/S2666273623000827congenital heart surgerysingle-ventricle congenital heart diseaseNorwoodneurodevelopmentmortalitylow birth weight |
| spellingShingle | Konstantin Averin, MD, MSc Lindsay Ryerson, MD Morteza Hajihosseini, MSc, PhD Irina A. Dinu, PhD Darren H. Freed, MD, PhD Gwen Bond, RN, MN Ari R. Joffe, MD De Villiers Jonker, MD Leonora Hendson, MD, MSc Charlene M.T. Robertson, MD Joseph Atallah, MDCM, SM Infants less than or equal to 2.5 kg have increased mortality and worse motor neurodevelopmental outcomes at 2 years of age after Norwood–Sano palliationCentral MessagePerspective JTCVS Open congenital heart surgery single-ventricle congenital heart disease Norwood neurodevelopment mortality low birth weight |
| title | Infants less than or equal to 2.5 kg have increased mortality and worse motor neurodevelopmental outcomes at 2 years of age after Norwood–Sano palliationCentral MessagePerspective |
| title_full | Infants less than or equal to 2.5 kg have increased mortality and worse motor neurodevelopmental outcomes at 2 years of age after Norwood–Sano palliationCentral MessagePerspective |
| title_fullStr | Infants less than or equal to 2.5 kg have increased mortality and worse motor neurodevelopmental outcomes at 2 years of age after Norwood–Sano palliationCentral MessagePerspective |
| title_full_unstemmed | Infants less than or equal to 2.5 kg have increased mortality and worse motor neurodevelopmental outcomes at 2 years of age after Norwood–Sano palliationCentral MessagePerspective |
| title_short | Infants less than or equal to 2.5 kg have increased mortality and worse motor neurodevelopmental outcomes at 2 years of age after Norwood–Sano palliationCentral MessagePerspective |
| title_sort | infants less than or equal to 2 5 kg have increased mortality and worse motor neurodevelopmental outcomes at 2 years of age after norwood sano palliationcentral messageperspective |
| topic | congenital heart surgery single-ventricle congenital heart disease Norwood neurodevelopment mortality low birth weight |
| url | http://www.sciencedirect.com/science/article/pii/S2666273623000827 |
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