Abstract
A clinician-driven home monitoring program can improve interstage outcomes in single-ventricle patients. Sociodemographic factors have been independently associated with mortality in interstage patients. We hypothesized that even in a population with high-risk sociodemographic characteristics, a home monitoring program is effective in reducing interstage mortality. We defined interstage period as the time period between discharge following Norwood palliation and second-stage surgery. We reviewed the charts of patients for the three-year period before (group 1) and after (group 2) implementation of the home monitoring program. Clinical variables around Norwood palliation, during the interstage period, and at the time of second-stage surgery were analyzed. There were 74 patients in group 1 and 52 in group 2. 59 % patients were Hispanic, and 84 % lived in neighborhoods where over 5 % families lived below poverty line. There was no significant difference in pre-Norwood variables, Norwood discharge variables, age at second surgery, or outcomes at second surgery. There were more Sano shunts performed at the Norwood procedure as the source of pulmonary blood flow in group 2 (p value <0.05). There were more unplanned hospital admissions and percutaneous re-interventions in group 2. Patients in group 2 whose admission criteria included desaturation had a 45 % likelihood of having an unplanned re-intervention. Group 2 noted an 80 % relative reduction in interstage mortality (p < 0.01). In a multiple regression analysis, after accounting for ethnicity, socio-economic status, and source of pulmonary blood flow, enrollment in a home monitoring program independently predicted improved interstage survival (p < 0.01). A clinician-driven home monitoring program reduces interstage mortality even when the majority of patients has high-risk sociodemographic characteristics.
Similar content being viewed by others
Abbreviations
- IS:
-
Interstage
- SVR:
-
Single-ventricle reconstruction
- CHLA:
-
Children’s Hospital Los Angeles
- BTS:
-
Blalock-Taussig shunt
- NPC-QIC:
-
National pediatric cardiology-quality improvement collaborative
References
Keller MD, Strickland MJ, Riehl-Colarusso T et al (2008) Prevalence of congenital heart defects in metropolitan Atlanta, 1998–2005. J Pediatr 153:807–813
Ghanayem NS, Tweddell JS, Hoffman GM et al (2006) Optimal timing of the second stage of palliation for hypoplastic left heart syndrome facilitated through home monitoring, and the results of early cavopulmonary anastomosis. Cardiol Young 16:61–66
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
Garcia X, Jarquiss RD, Imamura M et al (2011) Preemptive gastrostomy tube placement after Norwood operation. J Pediatr 159:602–607
Siehr SL, Norris JK, Bushnell JA et al (2014) Home monitoring program reduces interstage mortality after the modified Norwood procedure. J Thorac Cardiovasc Surg 147:718–723
Hehir DA, Dominguez TE, Ballweg JA et al (2008) Risk factors for interstage death after stage 1 reconstruction of hypoplastic left heart syndrome and variants. J Thorac Cardiovasc Surg 136:94–99
Song J, Kang I, Huh J et al (2013) Interstage mortality for functional single ventricle with heterotaxy syndrome: a retrospective study of the clinical experience of a single tertiary center. J Cardiothorac Surg 8:93
Petit CJ, Fraser CD, Mattamal R et al (2011) The impact of a dedicated single-ventricle home-monitoring program on interstage somatic growth, interstage attrition, and 1-year survival. J Thorac Cardiovasc Surg 142:1358–1366
Oster ME, Ehrlich A, King E et al (2015) Association of interstage home monitoring with mortality, readmissions, and weight gain: a multicenter study from the national pediatric cardiology quality improvement collaborative. Circulation 132:502–508
Pasquali SK, Ohye RG, Lu M et al (2012) Variation in perioperative care across centers for infants undergoing the Norwood procedure. J Thorac Cardiovasc Surg 144:915–921
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 31:143–148
Cross RR, Harahsheh AS, McCarter R et al (2014) Identified mortality risk factors associated with presentation, initial hospitalisation, and interstage period for the Norwood operation in a multi-centre registry: a report from the national pediatric cardiology-quality improvement collaborative. Cardiol Young 24:253–262
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 362:1980–1992
Acknowledgments
The authors would like to thank Hesham Mahmoud for assistance with obtaining IRB approval.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest relevant to this article to disclose.
Additional information
An erratum to this article is available at http://dx.doi.org/10.1007/s00246-016-1538-9.
Rights and permissions
About this article
Cite this article
Castellanos, D.A., Herrington, C., Adler, S. et al. Home Monitoring Program Reduces Mortality in High-Risk Sociodemographic Single-Ventricle Patients. Pediatr Cardiol 37, 1575–1580 (2016). https://doi.org/10.1007/s00246-016-1472-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-016-1472-x