Risk factors for prolonged length of stay after the stage 2 procedure in the single-ventricle reconstruction trial

Steven M. Schwartz, Minmin Lu, Richard G. Ohye, Kevin D. Hill, Andrew M. Atz, Maryam Y. Naim, Ismee A. Williams, Caren S. Goldberg, Alan Lewis, Frank Pigula, Peter Manning, Christian Pizarro, Paul Chai, Rachel McCandless, Carolyn Dunbar-Masterson, Jonathan R. Kaltman, Kirk Kanter, Lynn A. Sleeper, Julie V. Schonbeck, Nancy Ghanayem

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36 Scopus citations


Background The single-ventricle reconstruction trial randomized patients with single right ventricle lesions to a modified Blalock-Taussig or right ventricle-to-pulmonary artery shunt at the Norwood. This analysis describes outcomes at the stage 2 procedure and factors associated with a longer hospital length of stay (LOS). Methods We examined the association of shunt type with stage 2 hospital outcomes. Cox regression and bootstrapping were used to evaluate risk factors for longer LOS. We also examined characteristics associated with in-hospital death. Results There were 393 subjects in the analytic cohort. Median stage 2 procedure hospital LOS (8 days; interquartile range [IQR], 6-14 days), hospital mortality (4.3%), transplantation (0.8%), median ventilator time (2 days; IQR, 1-3 days), median intensive care unit LOS (4 days; IQR, 3-7 days), number of additional cardiac procedures or complications, and serious adverse events did not differ by shunt type. Longer LOS was associated (R2 = 0.26) with center, longer post-Norwood LOS (hazard ratio [HR], 1.93 per log day; P <.001), nonelective timing of the stage 2 procedure (HR, 1.78; P <.001), and pulmonary artery (PA) stenosis (HR, 1.56; P <.001). By univariate analysis, nonelective stage 2 (65% vs 32%; P =.009), moderate or greater atrioventricular valve (AVV) regurgitation (75% vs 24%; P <.001), and AVV repair (53% vs 9%; P <.001) were among the risk factors associated with in-hospital death. Conclusions Norwood LOS, PA stenoses, and nonelective stage 2 procedure, but not shunt type, are independently associated with longer LOS. Nonelective stage 2 procedure, moderate or greater AVV regurgitation, and need for AVV repair are among the risk factors for death.

Original languageEnglish
Pages (from-to)1791-1798.e4
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number6
StatePublished - Jun 2014


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