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

被引:17
作者
Brown, David W. [1 ,2 ]
Cohen, Katie E. [1 ,2 ]
O'Brien, Patricia [1 ,2 ]
Gauvreau, Kimberlee [1 ,2 ]
Klitzner, Thomas S. [3 ]
Beekman, Robert H., III [4 ]
Kugler, John D. [5 ]
Martin, Gerard R. [6 ]
Neish, Steven R. [7 ]
Rosenthal, Geoffrey L. [8 ]
Lannon, Carole [4 ]
Jenkins, Kathy J. [1 ,2 ]
机构
[1] Boston Childrens Hosp, Dept Cardiol, Boston, MA 02115 USA
[2] Boston Childrens Hosp, Dept Cardiac Surg, Boston, MA 02115 USA
[3] Mattel Childrens Hosp UCLA, Los Angeles, CA USA
[4] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA
[5] Univ Nebraska Med Ctr, Omaha, NE USA
[6] Childrens Natl Hlth Syst, Washington, DC USA
[7] Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
[8] Univ Maryland, Sch Med, Dept Pediat, Baltimore, MD 21201 USA
基金
美国医疗保健研究与质量局;
关键词
Cardiovascular disorders; Cardiovascular surgery; Quality improvement; Congenital heart disease; TECHNICAL PERFORMANCE SCORES; RECONSTRUCTION TRIAL; FETAL DIAGNOSIS; RISK-FACTORS; MORTALITY; OUTCOMES; BIRTH; CARE;
D O I
10.1007/s00246-014-1005-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:314 / 321
页数:8
相关论文
共 17 条
[1]   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].
Atz, Andrew M. ;
Travison, Thomas G. ;
Williams, Ismee A. ;
Pearson, Gail D. ;
Laussen, Peter C. ;
Mahle, William T. ;
Cook, Amanda L. ;
Kirsh, Joel A. ;
Sklansky, Mark ;
Khaikin, Svetlana ;
Goldberg, Caren ;
Frommelt, Michele ;
Krawczeski, Catherine ;
Puchalski, Michael D. ;
Jacobs, Jeffrey P. ;
Baffa, Jeanne M. ;
Rychik, Jack ;
Ohye, Richard G. .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2010, 140 (06) :1245-1250
[2]   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 [J].
Brown, David W. ;
Connor, Jean A. ;
Pigula, Frank A. ;
Usmani, Kudret ;
Klitzner, Thomas S. ;
Beekman, Robert H., III ;
Kugler, John D. ;
Martin, Gerard R. ;
Neish, Steven R. ;
Rosenthal, Geoffrey L. ;
Lannon, Carole ;
Jenkins, Kathy J. .
CONGENITAL HEART DISEASE, 2011, 6 (02) :108-115
[3]   Birth Before 39 Weeks' Gestation Is Associated With Worse Outcomes in Neonates With Heart Disease [J].
Costello, John M. ;
Polito, Angelo ;
Brown, David W. ;
McElrath, Thomas F. ;
Graham, Dionne A. ;
Thiagarajan, Ravi R. ;
Bacha, Emile A. ;
Allan, Catherine K. ;
Cohen, Jennifer N. ;
Laussen, Peter C. .
PEDIATRICS, 2010, 126 (02) :E277-E284
[4]  
Dooley Kenneth J, 2002, Crit Care Nurs Q, V25, P98
[5]   The incidence of congenital heart disease [J].
Hoffman, JIE ;
Kaplan, S .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 39 (12) :1890-1900
[6]   Prenatal Diagnosis of Hypoplastic Left Heart Syndrome in Current Era [J].
Kipps, Alaina K. ;
Feuille, Colin ;
Azakie, Anthony ;
Hoffman, Julien I. E. ;
Tabbutt, Sarah ;
Brook, Michael M. ;
Moon-Grady, Anita J. .
AMERICAN JOURNAL OF CARDIOLOGY, 2011, 108 (03) :421-427
[7]   Mortality and neurodevelopmental outcome at 1 year of age comparing hybrid and Norwood procedures [J].
Knirsch, Walter ;
Liamlahi, Rabia ;
Hug, Maja I. ;
Hoop, Ricarda ;
von Rhein, Michael ;
Pretre, Rene ;
Kretschmar, Oliver ;
Latal, Beatrice .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2012, 42 (01) :33-39
[8]   A decade of staged norwood palliation in hypoplastic left heart syndrome in a midsized cardiosurgical center [J].
Krasemann, T ;
Fenge, H ;
Kehl, HG ;
Rukosujew, A ;
Schmid, C ;
Scheld, HH ;
Tjan, TDT ;
Vogt, J .
PEDIATRIC CARDIOLOGY, 2005, 26 (06) :751-755
[9]   Prenatal Diagnosis of Congenital Heart Disease and Birth Outcomes [J].
Landis, Benjamin J. ;
Levey, Allison ;
Levasseur, Stephanie M. ;
Glickstein, Julie S. ;
Kleinman, Charles S. ;
Simpson, Lynn L. ;
Williams, Ismee A. .
PEDIATRIC CARDIOLOGY, 2013, 34 (03) :597-605
[10]   The Impact of Prenatal Diagnosis of Complex Congenital Heart Disease on Neonatal Outcomes [J].
Levey, Allison ;
Glickstein, Julie S. ;
Kleinman, Charles S. ;
Levasseur, Stephanie M. ;
Chen, Jonathan ;
Gersony, Welton M. ;
Williams, Ismee A. .
PEDIATRIC CARDIOLOGY, 2010, 31 (05) :587-597