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Outcomes in Patients with Persistent Ventricular Dysfunction After Stage I Palliation for Hypoplastic Left Heart Syndrome

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Abstract

We sought to describe the clinical course for patients with hypoplastic left heart syndrome and persistent ventricular dysfunction and identify risk factors for death or transplantation before stage II palliation. 138 children undergoing stage I palliation from 2004 to 2011 were reviewed. Twenty-two (16 %) patients (seven Hybrid, 15 Norwood) with two consecutive echocardiograms reporting at least moderate dysfunction were included and compared to case-matched controls. Eleven of the 22 patients with dysfunction (50 %) underwent stage II, seven (32 %) were transplanted, and four (18 %) died prior to stage II. Of the patients who survived to hospital discharge (n = 17) following stage 1, 14 (82 %) required readmission for heart failure (HF) compared to only two (10 %) for controls (p < 0.001). Among patients with ventricular dysfunction, there was an increased use of ACE inhibitors or beta-blockers (82 vs. 25 %; p = 0.001), inotropes (71 vs. 15 %; p = 0.001), ventilation (58 vs. 10 %; p = 0.001), and ECMO (29 vs. 0 %; p = 0.014) for HF management post-discharge when compared to controls. There was a lower heart transplant-free survival at 7 months in patients with dysfunction compared to controls (50.6 vs. 90.9 %; p = 0.040). ECMO support (p = 0.001) and duration of inotropic support (p = 0.04) were significantly associated with death or transplantation before stage II palliation. Patients with ventricular dysfunction received more HF management and related admissions. Longer inotropic support should prompt discussion regarding alternative treatment strategies given its association with death or transplant.

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Authors and Affiliations

  1. Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Emilie Jean-St-Michel

  2. Department of Paediatrics, University of Toronto, Toronto, ON, Canada

    Emilie Jean-St-Michel, Steven M. Schwartz & Alejandro A. Floh

  3. Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada

    Devin Chetan, Glen S. Van Arsdell & Osami Honjo

  4. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Devin Chetan, Glen S. Van Arsdell & Osami Honjo

  5. Department of Critical Care Medicine, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada

    Steven M. Schwartz & Alejandro A. Floh

  6. Division of Pediatric Cardiology, Stollery Children’s Hospital, Edmonton, AB, Canada

    Jennifer Conway

  7. Department of Pediatrics, University of Alberta, Edmonton, AB, Canada

    Jennifer Conway

Authors
  1. Emilie Jean-St-Michel
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  2. Devin Chetan
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  4. Glen S. Van Arsdell
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Correspondence to Emilie Jean-St-Michel.

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Jean-St-Michel, E., Chetan, D., Schwartz, S.M. et al. Outcomes in Patients with Persistent Ventricular Dysfunction After Stage I Palliation for Hypoplastic Left Heart Syndrome. Pediatr Cardiol 37, 239–247 (2016). https://doi.org/10.1007/s00246-015-1268-4

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  • DOI: https://doi.org/10.1007/s00246-015-1268-4

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