Skip to main content
Erschienen in: Pediatric Cardiology 2/2015

01.02.2015 | Original Article

Impact of Prenatal Diagnosis in Survivors of Initial Palliation of Single Ventricle Heart Disease

Analysis of the National Pediatric Cardiology Quality Improvement Collaborative Database

verfasst von: David W. Brown, Katie E. Cohen, Patricia O’Brien, Kimberlee Gauvreau, Thomas S. Klitzner, Robert H. Beekman III, John D. Kugler, Gerard R. Martin, Steven R. Neish, Geoffrey L. Rosenthal, Carole Lannon, Kathy J. Jenkins

Erschienen in: Pediatric Cardiology | Ausgabe 2/2015

Einloggen, um Zugang zu erhalten

Abstract

Among infants with single ventricle congenital heart disease (SVD) requiring Stage I palliation (S1P), the impact of prenatal diagnosis (PD) on outcomes has been variably characterized. We investigated the impact of PD in a large multi-center cohort of survivors of S1P in the National Pediatric Cardiology Quality Improvement Collaborative (NPCQIC) registry. Retrospective analysis of demographic and outcomes data among infants enrolled in the NPCQIC database; eligibility includes SVD requiring S1P and survival to discharge. From 43 contributing surgical centers, 591 infants had data available through time of BDG (519) or interstage death (55). Median gestational age was 39 weeks (31–46), and 66 % had variants of hypoplastic left heart syndrome. PD was made in 445 (75 %), with significant variation by center (p = 0.004). While infants with PD had slightly lower gestational age at birth (p < 0.001), there were no differences in birth weight, the presence of major syndromes or other organ system anomalies. Those without PD were more likely to have atrioventricular valve regurgitation (p = .002), ventricular dysfunction (p = 0.06), and pre-operative risk factors including acidosis (p < 0.001), renal insufficiency (p = 0.007), and shock (p = 0.05). Post-operative ventilation was shorter in the PD group (9 vs. 12 d, p = 0.002). Other early post-operative outcomes, interstage course, and outcomes at BDG were similar between groups. In a large cohort of infants with SVD surviving to hospital discharge after S1P, PD showed significant inter-site variation and was associated with improved pre-operative status and shorter duration of mechanical ventilation. The significance of such associations merits further study.
Literatur
1.
Zurück zum Zitat Atz AM, Travison TG, Williams IA, Pearson GD, Laussen PC, Mahle WT, Cook AL, Kirsh JA, Sklansky M, Khaikin S, Goldberg C, Frommelt M, Krawczeski C, Puchalski MD, Jacobs JP, Baffa JM, Rychik J, Ohye RG, Pediatric Heart Network I (2010) Prenatal diagnosis and risk factors for preoperative death in neonates with single right ventricle and systemic outflow obstruction: screening data from the Pediatric Heart Network Single Ventricle Reconstruction Trial(*). J Thorac Cardiovasc Surg 140:1245–1250PubMedCentralPubMedCrossRef Atz AM, Travison TG, Williams IA, Pearson GD, Laussen PC, Mahle WT, Cook AL, Kirsh JA, Sklansky M, Khaikin S, Goldberg C, Frommelt M, Krawczeski C, Puchalski MD, Jacobs JP, Baffa JM, Rychik J, Ohye RG, Pediatric Heart Network I (2010) Prenatal diagnosis and risk factors for preoperative death in neonates with single right ventricle and systemic outflow obstruction: screening data from the Pediatric Heart Network Single Ventricle Reconstruction Trial(*). J Thorac Cardiovasc Surg 140:1245–1250PubMedCentralPubMedCrossRef
2.
Zurück zum Zitat Brown DW, Connor JA, Pigula FA, Usmani K, Klitzner TS, Beekman RH 3rd, Kugler JD, Martin GR, Neish SR, Rosenthal GL, Lannon C, Jenkins KJ, Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement C (2011) Variation in preoperative and intraoperative care for first-stage palliation of single-ventricle heart disease: a report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. Congenit Heart Dis 6:108–115PubMedCrossRef Brown DW, Connor JA, Pigula FA, Usmani K, Klitzner TS, Beekman RH 3rd, Kugler JD, Martin GR, Neish SR, Rosenthal GL, Lannon C, Jenkins KJ, Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement C (2011) Variation in preoperative and intraoperative care for first-stage palliation of single-ventricle heart disease: a report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. Congenit Heart Dis 6:108–115PubMedCrossRef
3.
Zurück zum Zitat Costello JM, Polito A, Brown DW, McElrath TF, Graham DA, Thiagarajan RR, Bacha EA, Allan CK, Cohen JN, Laussen PC (2010) Birth before 39 weeks’ gestation is associated with worse outcomes in neonates with heart disease. Pediatrics 126:277–284PubMedCrossRef Costello JM, Polito A, Brown DW, McElrath TF, Graham DA, Thiagarajan RR, Bacha EA, Allan CK, Cohen JN, Laussen PC (2010) Birth before 39 weeks’ gestation is associated with worse outcomes in neonates with heart disease. Pediatrics 126:277–284PubMedCrossRef
4.
Zurück zum Zitat Dooley KJ, Bishop L (2002) Medical management of the cardiac infant and child after surgical discharge. Crit Care Nurs Q 25:98–104PubMedCrossRef Dooley KJ, Bishop L (2002) Medical management of the cardiac infant and child after surgical discharge. Crit Care Nurs Q 25:98–104PubMedCrossRef
5.
Zurück zum Zitat Hoffman JI, Kaplan S (2002) The incidence of congenital heart disease. J Am Coll Cardiol 39:1890–1900PubMedCrossRef Hoffman JI, Kaplan S (2002) The incidence of congenital heart disease. J Am Coll Cardiol 39:1890–1900PubMedCrossRef
6.
Zurück zum Zitat Kipps AK, Feuille C, Azakie A, Hoffman JI, Tabbutt S, Brook MM, Moon-Grady AJ (2011) Prenatal diagnosis of hypoplastic left heart syndrome in current era. Am J Cardiol 108:421–427PubMedCrossRef Kipps AK, Feuille C, Azakie A, Hoffman JI, Tabbutt S, Brook MM, Moon-Grady AJ (2011) Prenatal diagnosis of hypoplastic left heart syndrome in current era. Am J Cardiol 108:421–427PubMedCrossRef
7.
Zurück zum Zitat Knirsch W, Liamlahi R, Hug MI, Hoop R, von Rhein M, Pretre R, Kretschmar O, Latal B (2012) Mortality and neurodevelopmental outcome at 1 year of age comparing hybrid and Norwood procedures. Eur J Cardiothorac Surg 42:33–39PubMedCrossRef Knirsch W, Liamlahi R, Hug MI, Hoop R, von Rhein M, Pretre R, Kretschmar O, Latal B (2012) Mortality and neurodevelopmental outcome at 1 year of age comparing hybrid and Norwood procedures. Eur J Cardiothorac Surg 42:33–39PubMedCrossRef
8.
Zurück zum Zitat Krasemann T, Fenge H, Kehl HG, Rukosujew A, Schmid C, Scheld HH, Tjan TD, Vogt J (2005) A decade of staged Norwood palliation in hypoplastic left heart syndrome in a midsized cardiosurgical center. Pediatr Cardiol 26:751–755PubMedCrossRef Krasemann T, Fenge H, Kehl HG, Rukosujew A, Schmid C, Scheld HH, Tjan TD, Vogt J (2005) A decade of staged Norwood palliation in hypoplastic left heart syndrome in a midsized cardiosurgical center. Pediatr Cardiol 26:751–755PubMedCrossRef
9.
Zurück zum Zitat Landis BJ, Levey A, Levasseur SM, Glickstein JS, Kleinman CS, Simpson LL, Williams IA (2013) Prenatal diagnosis of congenital heart disease and birth outcomes. Pediatr Cardiol 34:597–605PubMedCentralPubMedCrossRef Landis BJ, Levey A, Levasseur SM, Glickstein JS, Kleinman CS, Simpson LL, Williams IA (2013) Prenatal diagnosis of congenital heart disease and birth outcomes. Pediatr Cardiol 34:597–605PubMedCentralPubMedCrossRef
10.
Zurück zum Zitat Levey A, Glickstein JS, Kleinman CS, Levasseur SM, Chen J, Gersony WM, Williams IA (2010) The impact of prenatal diagnosis of complex congenital heart disease on neonatal outcomes. Pediatr Cardiol 31:587–597PubMedCentralPubMedCrossRef Levey A, Glickstein JS, Kleinman CS, Levasseur SM, Chen J, Gersony WM, Williams IA (2010) The impact of prenatal diagnosis of complex congenital heart disease on neonatal outcomes. Pediatr Cardiol 31:587–597PubMedCentralPubMedCrossRef
11.
Zurück zum Zitat McGuirk SP, Griselli M, Stumper OF, Rumball EM, Miller P, Dhillon R, de Giovanni JV, Wright JG, Barron DJ, Brawn WJ (2006) Staged surgical management of hypoplastic left heart syndrome: a single institution 12 year experience. Heart 92:364–370PubMedCentralPubMedCrossRef McGuirk SP, Griselli M, Stumper OF, Rumball EM, Miller P, Dhillon R, de Giovanni JV, Wright JG, Barron DJ, Brawn WJ (2006) Staged surgical management of hypoplastic left heart syndrome: a single institution 12 year experience. Heart 92:364–370PubMedCentralPubMedCrossRef
12.
Zurück zum Zitat Nathan M, Karamichalis JM, Liu H, Emani S, Baird C, Pigula F, Colan S, Thiagarajan RR, Bacha EA, Del Nido P (2012) Surgical technical performance scores are predictors of late mortality and unplanned reinterventions in infants after cardiac surgery. J Thorac Cardiovasc Surg 144(1095–1101):e1097 Nathan M, Karamichalis JM, Liu H, Emani S, Baird C, Pigula F, Colan S, Thiagarajan RR, Bacha EA, Del Nido P (2012) Surgical technical performance scores are predictors of late mortality and unplanned reinterventions in infants after cardiac surgery. J Thorac Cardiovasc Surg 144(1095–1101):e1097
13.
Zurück zum Zitat Nathan M, Karamichalis J, Liu H, Gauvreau K, Colan S, Saia M, Pigula F, Fynn-Thompson F, Emani S, Baird C, Mayer JE, del Nido PJ (2014) Technical Performance Scores are strongly associated with early mortality, postoperative adverse events, and intensive care unit length of stay-analysis of consecutive discharges for 2 years. J Thorac Cardiovasc Surg 147:389–394 396 e381–396 e383PubMedCrossRef Nathan M, Karamichalis J, Liu H, Gauvreau K, Colan S, Saia M, Pigula F, Fynn-Thompson F, Emani S, Baird C, Mayer JE, del Nido PJ (2014) Technical Performance Scores are strongly associated with early mortality, postoperative adverse events, and intensive care unit length of stay-analysis of consecutive discharges for 2 years. J Thorac Cardiovasc Surg 147:389–394 396 e381–396 e383PubMedCrossRef
14.
Zurück zum Zitat Newburger JW, Sleeper LA, Bellinger DC, Goldberg CS, Tabbutt S, Lu M, Mussatto KA, Williams IA, Gustafson KE, Mital S, Pike N, Sood E, Mahle WT, Cooper DS, Dunbar-Masterson C, Krawczeski CD, Lewis A, Menon SC, Pemberton VL, Ravishankar C, Atz TW, Ohye RG, Gaynor JW, Pediatric Heart Network I (2012) Early developmental outcome in children with hypoplastic left heart syndrome and related anomalies: the single ventricle reconstruction trial. Circulation 125:2081–2091PubMedCentralPubMedCrossRef Newburger JW, Sleeper LA, Bellinger DC, Goldberg CS, Tabbutt S, Lu M, Mussatto KA, Williams IA, Gustafson KE, Mital S, Pike N, Sood E, Mahle WT, Cooper DS, Dunbar-Masterson C, Krawczeski CD, Lewis A, Menon SC, Pemberton VL, Ravishankar C, Atz TW, Ohye RG, Gaynor JW, Pediatric Heart Network I (2012) Early developmental outcome in children with hypoplastic left heart syndrome and related anomalies: the single ventricle reconstruction trial. Circulation 125:2081–2091PubMedCentralPubMedCrossRef
15.
Zurück zum Zitat Peiris V, Singh TP, Tworetzky W, Chong EC, Gauvreau K, Brown DW (2009) Association of socioeconomic position and medical insurance with fetal diagnosis of critical congenital heart disease. Circ Cardiovasc Qual Outcomes 2:354–360PubMedCrossRef Peiris V, Singh TP, Tworetzky W, Chong EC, Gauvreau K, Brown DW (2009) Association of socioeconomic position and medical insurance with fetal diagnosis of critical congenital heart disease. Circ Cardiovasc Qual Outcomes 2:354–360PubMedCrossRef
16.
Zurück zum Zitat Tabbutt S, Ghanayem N, Ravishankar C, Sleeper LA, Cooper DS, Frank DU, Lu M, Pizarro C, Frommelt P, Goldberg CS, Graham EM, Krawczeski CD, Lai WW, Lewis A, Kirsh JA, Mahony L, Ohye RG, Simsic J, Lodge AJ, Spurrier E, Stylianou M, Laussen P, Pediatric Heart Network I (2012) Risk factors for hospital morbidity and mortality after the Norwood procedure: a report from the Pediatric Heart Network Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg 144:882–895PubMedCrossRef Tabbutt S, Ghanayem N, Ravishankar C, Sleeper LA, Cooper DS, Frank DU, Lu M, Pizarro C, Frommelt P, Goldberg CS, Graham EM, Krawczeski CD, Lai WW, Lewis A, Kirsh JA, Mahony L, Ohye RG, Simsic J, Lodge AJ, Spurrier E, Stylianou M, Laussen P, Pediatric Heart Network I (2012) Risk factors for hospital morbidity and mortality after the Norwood procedure: a report from the Pediatric Heart Network Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg 144:882–895PubMedCrossRef
17.
Zurück zum Zitat Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH (2001) Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 103:1269–1273PubMedCrossRef Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH (2001) Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 103:1269–1273PubMedCrossRef
Metadaten
Titel
Impact of Prenatal Diagnosis in Survivors of Initial Palliation of Single Ventricle Heart Disease
Analysis of the National Pediatric Cardiology Quality Improvement Collaborative Database
verfasst von
David W. Brown
Katie E. Cohen
Patricia O’Brien
Kimberlee Gauvreau
Thomas S. Klitzner
Robert H. Beekman III
John D. Kugler
Gerard R. Martin
Steven R. Neish
Geoffrey L. Rosenthal
Carole Lannon
Kathy J. Jenkins
Publikationsdatum
01.02.2015
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 2/2015
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-014-1005-4

Weitere Artikel der Ausgabe 2/2015

Pediatric Cardiology 2/2015 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.