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Digoxin Use in Infants with Single Ventricle Physiology: Secondary Analysis of the Pediatric Heart Network Infant Single Ventricle Trial Public Use Dataset

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Abstract

Digoxin has been associated with reduced interstage mortality after Norwood procedure. We sought to determine its association with survival and change in weight-for-age Z-score (WAZ) before the superior cavopulmonary connection (SCPC) surgery and at 14 months in a heterogeneous group of single ventricle infants. We performed a post-hoc analysis of the Pediatric Heart Network Infant Single Ventricle public use dataset to determine associations between digoxin and survival, transplant-free survival, and change in WAZ pre-SCPC and at 14 months. Sub-analyses of survival and transplant-free survival were performed for subjects who underwent Damus–Kaye–Stansel (DKS)/Norwood. Propensity score weighting was used in Cox hazard-proportion models. Of 229 subjects, 82 (36%) received digoxin and 147 (64%) received no digoxin. Pre-SCPC and 14-month survival and transplant-free survival were not significantly different between the digoxin and no digoxin groups for the main cohort and DKS/Norwood sub-group. However, in DKS/Norwood subjects there was a trend towards improved interstage transplant-free survival in the digoxin group (95.7 vs. 89.6%, p = 0.08). Digoxin was associated with a greater decrease in WAZ from birth to pre-SCPC (− 1.96 ± 0.19 vs. − 1.31 ± 0.18, p < 0.001) and birth to 14 months (− 0.64 ± 0.15 vs. − 0.19 ± 0.15, p = 0.03). Digoxin was not associated with improved survival during the interstage or at 14 months in a mixed single ventricle cohort, but there was a trend towards improved interstage transplant-free survival in post-Norwood infants. As digoxin was associated with poorer weight gain, further research is needed to identify the risks/benefits for anatomic subtypes of infants with single ventricles.

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References

  1. Fixler DE, Nembhard WN, Salemi JL et al (2010) Mortality in first 5 years in infants with functional single ventricle born in Texas, 1996 to 2003. Circulation 121:644–650. https://doi.org/10.1161/CIRCULATIONAHA.109.881904

    Article  PubMed  Google Scholar 

  2. Boneva RS, Botto LD, Moore CA et al (2001) Mortality associated with congenital heart defects in the United States: trends and racial disparities, 1979–1997. Circulation 103:2376–2381. https://doi.org/10.1161/01.cir.103.19.2376

    Article  PubMed  CAS  Google Scholar 

  3. Cleves MA, Ghaffar S, Zhao W et al (2003) First-year survival of infants born with congenital heart defects in Arkansas (1993–1998): a survival analysis using registry data. Birth Defects Res A 67:662–668. https://doi.org/10.1002/bdra.10119

    Article  CAS  Google Scholar 

  4. D’Udekem Y, Xu MY, Galati JC et al (2012) Predictors of survival after single-ventricle palliation: the impact of right ventricular dominance. J Am Coll Cardiol 59:1178–1185. https://doi.org/10.1016/j.jacc.2011.11.049

    Article  PubMed  Google Scholar 

  5. Ghanayem NS, Allen KR, Tabbutt S et al (2012) Interstage mortality after the Norwood procedure: results of the multicenter single ventricle reconstruction trial. J Thorac Cardiovasc Surg 144:896–906. https://doi.org/10.1016/j.jtcvs.2012.05.020

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ghanayem NS, Hoffman GM, Mussatto K et al (2003) Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg 126:1367–1377. https://doi.org/10.1016/S0022-5223(03)00071-0

    Article  PubMed  CAS  Google Scholar 

  7. Rudd N, Frommelt M, Tweddell JS et al (2014) Improving interstage survival after Norwood operation: outcomes from 10 years of home monitoring. J Thorac Cardiovasc Surg 148:1540–1547. https://doi.org/10.1016/j.jtcvs.2014.02.038

    Article  PubMed  Google Scholar 

  8. Anderson JB, Beekman RH, Kugler JD et al (2015) Improvement in interstage survival in a national pediatric cardiology learning network. Circ Cardiovasc Qual Outcomes 8:428–436. https://doi.org/10.1161/CIRCOUTCOMES.115.001956

    Article  PubMed  Google Scholar 

  9. Brown DW, Mangeot C, Anderson JB et al (2016) Digoxin use is associated with reduced interstage mortality in patients with no history of arrhythmia after stage I palliation for single ventricle heart disease. J Am Heart Assoc 5:e002376. https://doi.org/10.1161/JAHA.115.002376

    Article  PubMed  PubMed Central  Google Scholar 

  10. Oster ME, Kelleman M, McCracken C et al (2016) Association of digoxin with interstage mortality: results from the pediatric heart network single ventricle reconstruction trial public use dataset. J Am Heart Assoc 5:e002566. https://doi.org/10.1161/JAHA.115.002566

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ghelani SJ, Spurney CF, Martin GR, Cross RR (2013) Impact of pharmacotherapy on interstage mortality and weight gain in children with single ventricle. Congenit Heart Dis 8:219–227. https://doi.org/10.1111/chd.12020

    Article  PubMed  Google Scholar 

  12. Mattamal R, Ocampo EC, Petit CJ (2011) Impact of pharmacotherapy on interstage outcomes in single ventricle infants. Congenit Heart Dis 6:286–293. https://doi.org/10.1111/j.1747-0803.2011.00536.x

    Article  PubMed  Google Scholar 

  13. Hsu DT, Zak V, Mahony L et al (2010) Enalapril in infants with single ventricle: results of a multicenter randomized trial. Circulation 122:333–340. https://doi.org/10.1161/CIRCULATIONAHA.109.927988

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Anderson JB, Beekman RH, Border WL et al (2009) Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. J Thorac Cardiovasc Surg 138:397–404.e1. https://doi.org/10.1016/j.jtcvs.2009.02.033

    Article  PubMed  Google Scholar 

  15. Menon SC, McCandless RT, MacK GK et al (2013) Clinical outcomes and resource use for infants with hypoplastic left heart syndrome during bidirectional Glenn: summary from the joint council for congenital heart disease national pediatric cardiology quality improvement collaborative registry. Pediatr Cardiol 34:143–148. https://doi.org/10.1007/s00246-012-0403-8

    Article  PubMed  Google Scholar 

  16. Mitting R, Marino L, Macrae D et al (2015) Nutritional status and clinical outcome in postterm neonates undergoing surgery for congenital heart disease. Pediatr Crit Care Med 16:448–452. https://doi.org/10.1097/PCC.0000000000000402

    Article  PubMed  Google Scholar 

  17. Radman M, Mack R, Barnoya J et al (2014) Post-operative outcomes in children undergoing surgery for congenital heart defects in san. J Thorac Cardiovasc Surg 147:1–17. https://doi.org/10.1016/j.jtcvs.2013.03.023.THE

    Article  Google Scholar 

  18. Castleberry C, White-Williams C, Naftel D et al (2014) Hypoalbuminemia and poor growth predict worse outcomes in pediatric heart transplant recipients. Pediatr Transpl 18:280–287. https://doi.org/10.1111/petr.12239

    Article  Google Scholar 

  19. Burch PT, Spigarelli MG, Lambert LM et al (2016) Use of oxandrolone to promote growth in neonates following surgery for complex congenital heart disease: an open-label pilot trial. Congenit Heart Dis. https://doi.org/10.1111/chd.12376

    Article  PubMed  Google Scholar 

  20. Miller TL, Neri D, Extein J et al (2007) Nutrition in pediatric cardiomyopathy. Prog Pediatr Cardiol 24:59–71

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 8UL1TR000105 (formerly UL1RR025764).

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Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, University of Utah and Primary Children’s Hospital, 81 North Mario Capecchi Drive, Salt Lake City, UT, 84113, USA

    Dongngan T. Truong, Shaji C. Menon, L. LuAnn Minich & Richard V. Williams

  2. Division of Pediatric Cardiothoracic Surgery, Department of Surgery, University of Utah and Primary Children’s Hospital, 81 North Mario Capecchi Drive, Salt Lake City, UT, 84113, USA

    Linda M. Lambert

  3. Cook Children’s Medical Center, 801 7th Ave., Fort Worth, TX, 76104, USA

    Phillip T. Burch

  4. Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA

    Xiaoming Sheng

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  1. Dongngan T. Truong
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  2. Shaji C. Menon
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  3. Linda M. Lambert
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  4. Phillip T. Burch
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  5. Xiaoming Sheng
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  6. L. LuAnn Minich
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  7. Richard V. Williams
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Correspondence to Dongngan T. Truong.

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Truong, D.T., Menon, S.C., Lambert, L.M. et al. Digoxin Use in Infants with Single Ventricle Physiology: Secondary Analysis of the Pediatric Heart Network Infant Single Ventricle Trial Public Use Dataset. Pediatr Cardiol 39, 1200–1209 (2018). https://doi.org/10.1007/s00246-018-1884-x

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  • DOI: https://doi.org/10.1007/s00246-018-1884-x

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