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Utility of the NEONATE Score at an Institution that Routinely Performs the Hybrid Procedure for Hypoplastic Left Heart Syndrome

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Abstract

NEONATE score > 17 has been proposed as a risk factor for interstage mortality/cardiac transplant (IM/T) for patients with single ventricle physiology. Hybrid procedure is assigned 6 points, the highest possible score for that surgical variable. Most centers reserve the hybrid procedure for high-risk patients. Goal of this study was to evaluate the NEONATE score at a center that routinely performs the hybrid procedure. Retrospective chart review of patients undergoing the hybrid procedure was performed (2008–2021). Demographics and variables used for the NEONATE score were collected. Maximization of Youden’s J Statistic used to determine cohort-specific optimal threshold for patients undergoing comprehensive Stage II procedure (H-CSII) versus those with IM/T (H-IM/T). Total of 120 patients met inclusion criteria (H-CSII = 105, H-IM/T = 15). Gestational age was median 39 weeks (IQR 38, 39) and birth weight was 3.18 kg (2.91, 3.57). No patient was discharged with opiates or required post-operative extracorporeal circulatory support. Optimal threshold, as selected by maximizing Youden’s J Statistic, was 22. Score > 22 had a positive predictive value of 0.33 (95% CI 0.12–0.62), negative predictive values of 0.90 (95% CI 0.83–0.95), and accuracy of 0.83 (95% CI 0.75–0.90) for IM/T. At a center that routinely performs the hybrid procedure, value of > 22 had the highest accuracy. This suggests that the hybrid procedure is not necessarily intrinsically a risk-factor for IM/T, but rather patient selection for the hybrid procedure may play a larger role at centers that do not routinely perform this procedure.

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References

  1. Ghanayem NS, Hoffman GM, Mussatto KA et al (2003) Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg 126(5):1367–1377

    Article  CAS  PubMed  Google Scholar 

  2. 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(4):896–906

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ohye RG, Sleeper LA, Mahony L et al (2010) Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med 362(21):1980–1992

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Cua CL, Thiagarajan RR, Taeed R et al (2005) Improved interstage mortality with the modified Norwood procedure: a meta-analysis. Ann Thorac Surg 80(1):44–49

    Article  PubMed  Google Scholar 

  5. Meza JM, Hickey EJ, Blackstone EH et al (2017) The optimal timing of stage 2 palliation for hypoplastic left heart syndrome: an analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial Public Data Set. Circulation 136(18):1737–1748

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ahmed H, Anderson JB, Bates KE et al (2020) Development of a validated risk score for interstage death or transplant after stage I palliation for single-ventricle heart disease. J Thorac Cardiovasc Surg 160(4):1021–1030

    Article  PubMed  Google Scholar 

  7. Wilder TJ, McCrindle BW, Hickey EJ et al (2017) Is a hybrid strategy a lower-risk alternative to stage 1 Norwood operation? J Thorac Cardiovasc Surg 153(1):163–172e166

    Article  PubMed  Google Scholar 

  8. Sower CT, Romano JC, Yu S, Lowery R, Pasquali SK, Zampi JD (2019) Early and midterm outcomes in high-risk single-ventricle patients: hybrid vs Norwood palliation. Ann Thorac Surg 108(6):1849–1855

    Article  PubMed  Google Scholar 

  9. Karamlou T, Overman D, Hill KD et al (2015) Stage 1 hybrid palliation for hypoplastic left heart syndrome—assessment of contemporary patterns of use: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 149(1):195–201 (202 e191)

    Article  PubMed  Google Scholar 

  10. Yates AR, Hoffman TM, Boettner B, Feltes TF, Cua CL (2011) Initial counseling prior to palliation for hypoplastic left heart syndrome. Congenit Heart Dis 6(4):347–358

    Article  PubMed  Google Scholar 

  11. Galantowicz M, Cheatham JP, Phillips A et al (2008) Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. Ann Thorac Surg 85(6):2063–2070 (discussion 2070–2061)

    Article  PubMed  Google Scholar 

  12. Schranz D, Bauer A, Reich B et al (2015) Fifteen-year single center experience with the “Giessen Hybrid” approach for hypoplastic left heart and variants: current strategies and outcomes. Pediatr Cardiol 36(2):365–373

    Article  PubMed  Google Scholar 

  13. Cua CL, McConnell PI, Meza JM et al (2018) Hybrid palliation: outcomes after the comprehensive stage 2 procedure. Ann Thorac Surg 105(5):1455–1460

    Article  PubMed  Google Scholar 

  14. Fenstermaker B, Berger GE, Rowland DG et al (2008) Interstage echocardiographic changes in patients undergoing hybrid stage I palliation for hypoplastic left heart syndrome. J Am Soc Echocardiogr 21(11):1222–1228

    Article  PubMed  Google Scholar 

  15. Youden WJ (1950) Index for rating diagnostic tests. Cancer 3(1):32–35

    Article  CAS  PubMed  Google Scholar 

  16. Robin X, Turck N, Hainard A et al (2011) pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinform 12:77

    Article  Google Scholar 

  17. Sunthankar SD, Zhao J, Wei WQ et al (2023) Machine learning to predict interstage mortality following single ventricle palliation: a NPC-QIC database analysis. Pediatr Cardiol 44(6):1242–1250. https://doi.org/10.1007/s00246-023-03130-z

    Article  PubMed  Google Scholar 

  18. Debrunner MG, Porayette P, Breinholt 3rd JP, Turrentine MW, Cordes TM (2013) Midterm survival of infants requiring postoperative extracorporeal membrane oxygenation after Norwood palliation. Pediatr Cardiol 34(3):570–575

    Article  PubMed  Google Scholar 

  19. Fernandez RP, Joy BF, Allen R et al (2017) Interstage survival for patients with hypoplastic left heart syndrome after ECMO. Pediatr Cardiol 38(1):50–55

    Article  PubMed  Google Scholar 

  20. Mitchell EA, Gomez D, Joy BF et al (2016) ECMO: incidence and outcomes of patients undergoing the hybrid procedure. Congenit Heart Dis 11(2):169–174

    Article  PubMed  Google Scholar 

  21. 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(1):e002376. https://doi.org/10.1161/JAHA.115.002376

    Article  PubMed  PubMed Central  Google Scholar 

  22. Truong DT, Menon SC, Lambert LM et al (2018) 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(6):1200–1209

    Article  PubMed  Google Scholar 

  23. Brown TN, Brown DW, Tweddell JS, Bates KE, Lannon CM, Anderson JB (2022) Digoxin associated with greater transplant-free survival in high- vs low-risk interstage patients. Ann Thorac Surg 114(4):1453–1459

    Article  PubMed  Google Scholar 

  24. Mienert T, Esmaeili A, Steinbrenner B et al (2021) Cardiovascular drug therapy during interstage after hybrid approach: a single-center experience in 51 newborns with hypoplastic left heart. Paediatr Drugs 23(2):195–202

    Article  PubMed  PubMed Central  Google Scholar 

  25. Czosek RJ, Spar DS, Anderson JB, Khoury PR, Webster G (2022) Predictors and outcomes of arrhythmia on stage I palliation of single ventricle patients. JACC Clin Electrophysiol 8(9):1136–1144

    Article  PubMed  Google Scholar 

  26. Moore J, Paulus D, Cua CL et al (2016) Arrhythmias after stage I hybrid palliation in single-ventricle patients. Pediatr Cardiol 37(8):1416–1421

    Article  PubMed  Google Scholar 

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Acknowledgements

This research was supported by the Ohio Perinatal Research Network (OPRN) at Nationwide Children’s Hospital. OPRN is supported by the Center for Perinatal Research at Nationwide Children’s Hospital. Funding is provided by the Abigail Wexner Research Institute at Nationwide Children’s Hospital.

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Authors and Affiliations

  1. Heart Center, Nationwide Children’s Hospital, Columbus, OH, 43205, USA

    Holly Miller-Tate, Samantha Fichtner, Jo Ann Davis, Chance Alvarado, Amee M. Bigelow, Lydia Wright, Mark Galantowicz & Clifford L. Cua

  2. Biostatistics Resource, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, 43205, USA

    Chance Alvarado & Sara Conroy

  3. The Ohio Perinatal Research Network, Center for Perinatal Research, Nationwide Children’s Hospital, Columbus, OH, 43205, USA

    Chance Alvarado & Sara Conroy

  4. Center for Biostatistics, The Ohio State University, Wexner Medical Center, Columbus, OH, 43210, USA

    Chance Alvarado & Sara Conroy

  5. Department of Pediatrics, Heart Center, Nationwide Children’s Hospital, Columbus, OH, 43205, USA

    Clifford L. Cua

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  1. Holly Miller-Tate
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  2. Samantha Fichtner
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  3. Jo Ann Davis
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  4. Chance Alvarado
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  5. Sara Conroy
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  6. Amee M. Bigelow
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  7. Lydia Wright
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  8. Mark Galantowicz
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  9. Clifford L. Cua
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Contributions

HM-T, JAD, and CLC—Conceptual design; HM-T and CLC—Writing initial draft; CA and SC—Statistical analysis; All authors reviewed the manuscript.

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Correspondence to Clifford L. Cua.

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Miller-Tate, H., Fichtner, S., Davis, J.A. et al. Utility of the NEONATE Score at an Institution that Routinely Performs the Hybrid Procedure for Hypoplastic Left Heart Syndrome. Pediatr Cardiol 44, 1684–1690 (2023). https://doi.org/10.1007/s00246-023-03223-9

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  • DOI: https://doi.org/10.1007/s00246-023-03223-9

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