TY - JOUR
T1 - Can We Still Improve Survival Outcomes of Neonatal Biventricular Repairs?
AU - Luo, Shuhua
AU - Haller, Christoph
AU - Fan, Chun po Steve
AU - Moss, Kasey
AU - Manlhiot, Cedric
AU - Xie, Wenli
AU - Moinshaghaghi, Ali
AU - Haranal, Maruti
AU - Schwartz, Steven
AU - Caldarone, Christopher
AU - Van Arsdell, Glen S.
AU - Honjo, Osami
N1 - Publisher Copyright:
© 2021 The Society of Thoracic Surgeons
PY - 2021/1
Y1 - 2021/1
N2 - Background: We sought to identify modifiable factors to improve survival of neonatal biventricular repair by analyzing the cause of death and predictors of mortality and reintervention in the last 2 decades. Methods: Between 1995 and 2016, 991 consecutive neonates were included. The cohort was divided by era: era I was from 1995 to 1999, era II 2000 to 2007, and era III 2008 to 2016. The Kaplan-Meier method was used to estimate freedom from death and reintervention. Univariable and multivariable Cox regression was applied to assess predictors for mortality or reintervention in the contemporary cohorts (2000-2016). Results: Median age was 8 days (range, 5-13), and median body weight at operation was 3.3 kg (range, 2.9-3.6). The most common diagnosis was transposition with intact ventricular septum (32%), followed by transposition with ventricular septal defect (14.5%), and simple left-to-right shunt lesion (10.9%). There was significant improvement in survival from era I to eras II and III but no difference between eras II and III (1 year: 82.1% vs 89.4% vs 89.6%, respectively; P <.001). The most common cause of death was sudden death in eras I and III and cardiac in era II. Multivariable analysis revealed preoperative (P =.005)/postoperative (P <.001) extracorporeal membrane oxygenation and postoperative renal replacement (P <.001) as independent predictors for mortality. The reintervention rates were comparable between eras II and III (P =.53). Atrioventricular septal defects and common atrial trunk were identified as predictors for reintervention. Conclusions: Survival after neonatal biventricular repair remained unchanged. Preventing sudden death, myocardial protection, and minimizing residual lesions are potential targets to improve outcomes.
AB - Background: We sought to identify modifiable factors to improve survival of neonatal biventricular repair by analyzing the cause of death and predictors of mortality and reintervention in the last 2 decades. Methods: Between 1995 and 2016, 991 consecutive neonates were included. The cohort was divided by era: era I was from 1995 to 1999, era II 2000 to 2007, and era III 2008 to 2016. The Kaplan-Meier method was used to estimate freedom from death and reintervention. Univariable and multivariable Cox regression was applied to assess predictors for mortality or reintervention in the contemporary cohorts (2000-2016). Results: Median age was 8 days (range, 5-13), and median body weight at operation was 3.3 kg (range, 2.9-3.6). The most common diagnosis was transposition with intact ventricular septum (32%), followed by transposition with ventricular septal defect (14.5%), and simple left-to-right shunt lesion (10.9%). There was significant improvement in survival from era I to eras II and III but no difference between eras II and III (1 year: 82.1% vs 89.4% vs 89.6%, respectively; P <.001). The most common cause of death was sudden death in eras I and III and cardiac in era II. Multivariable analysis revealed preoperative (P =.005)/postoperative (P <.001) extracorporeal membrane oxygenation and postoperative renal replacement (P <.001) as independent predictors for mortality. The reintervention rates were comparable between eras II and III (P =.53). Atrioventricular septal defects and common atrial trunk were identified as predictors for reintervention. Conclusions: Survival after neonatal biventricular repair remained unchanged. Preventing sudden death, myocardial protection, and minimizing residual lesions are potential targets to improve outcomes.
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U2 - 10.1016/j.athoracsur.2020.03.008
DO - 10.1016/j.athoracsur.2020.03.008
M3 - Article
C2 - 32268140
AN - SCOPUS:85084413389
VL - 111
SP - 199
EP - 205
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 1
ER -