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Postoperative heart failure after stage 1 palliative surgery for single ventricle cardiac disease

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Abstract

Outcomes for patients with single ventricle congenital heart disease (SV-CHD) continue to improve over time. However, the prognosis for patients who develop heart failure immediately after surgery is poorly understood. We conducted a single-center, retrospective cohort study of patients with SV-CHD, who suffered postoperative heart failure. Of 1038 cardiac surgeries performed on 621 SV-CHD patients between 2004 and 2010, 125 patients met inclusion criteria, including non-septatable anatomy, stage 1 surgery, and verified low cardiac output or heart failure state per STS definition. Overall survival was 73.2% at 2 months, 64.9% at 1 year, 60.5% at 2 years, and 54.6% at 4 years. Inotrope dependence beyond 7 days post-op yielded 45% 2-year survival versus 68% for those who weaned from inotropes within 7 days (p = 0.02). Atrioventricular valve regurgitation (AVVR) influenced survival, and patients who developed renal failure or required ECMO fared poorly, even when they survived their hospitalization. Patients with postoperative heart failure and low cardiac output syndrome constitute a high-risk population beyond the term of the initial hospitalization and have an overall mid-term survival of 55% at 4 years. Wean from inotropic therapy is not completely reassuring in this population, as they have ongoing elevated risk of cardiac failure and death in the medium term. Ventricular dysfunction, AVVR, renal failure, and need for ECMO are all important prognostic factors for mid-term mortality. Inotrope dependence for > 7 days has important implications reaching beyond the hospitalization.

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Authors and Affiliations

  1. Department of Anesthesia, University of Washington Medical Center, Seattle, WA, USA

    Michael G. Foulks

  2. Department of Child and Adolescent Development, California State University, Northridge, CA, USA

    Rika M. L. Meyer

  3. Keck School of Medicine, Department of Pediatrics, University of Southern California, Los Angeles, CA, USA

    Jeffrey I. Gold

  4. Division of Cardiothoracic Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Cynthia S. Herrington

  5. Cardiovascular Surgery, Kaiser Permanente Los Angeles, Los Angeles, CA, USA

    Kristopher Kallin

  6. Division of Cardiology, Children’s Hospital Los Angeles, MS#34 4650 W. Sunset Blvd, Los Angeles, CA, 90027, USA

    JonDavid Menteer

Authors
  1. Michael G. Foulks
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  2. Rika M. L. Meyer
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  3. Jeffrey I. Gold
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Correspondence to JonDavid Menteer.

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Conflict of interest

Michael G Foulks declares that he has no conflict of interest to disclose. Rika M. L. Meyer declares that she has no conflict of interest to disclose. Jeffrey I. Gold declares that he has no conflict of interest to disclose. Cynthia S. Herrington declares that she has no conflict of interest to disclose. Kristopher Kallin declares that he has no conflict of interest to disclose. JonDavid Menteer declares that he has no conflict of interest to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Foulks, M.G., Meyer, R.M.L., Gold, J.I. et al. Postoperative heart failure after stage 1 palliative surgery for single ventricle cardiac disease. Pediatr Cardiol 40, 943–949 (2019). https://doi.org/10.1007/s00246-019-02093-4

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  • DOI: https://doi.org/10.1007/s00246-019-02093-4

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