Home surveillance program prevents interstage mortality after the Norwood procedure

J Thorac Cardiovasc Surg. 2003 Nov;126(5):1367-77. doi: 10.1016/s0022-5223(03)00071-0.


Objective: To determine whether early identification of physiologic variances associated with interstage death would reduce mortality, we developed a home surveillance program.

Methods: Patients discharged before initiation of home surveillance (group A, n = 63) were compared with patients discharged with an infant scale and pulse oximeter (group B, n = 24). Parents maintained a daily log of weight and arterial oxygen saturation according to pulse oximetry and were instructed to contact their physician in case of an arterial oxygen saturation less than 70% according to pulse oximetry, an acute weight loss of more than 30 g in 24 hours, or failure to gain at least 20 g during a 3-day period.

Results: Interstage mortality among infants surviving to discharge was 15.8% (n = 9/57) in group A and 0% (n = 0/24) in group B (P =.039). Surveillance criteria were breached for 13 of 24 group B patients: 12 patients with decreased arterial oxygen saturation according to pulse oximetry with or without poor weight gain and 1 patient with poor weight gain alone. These 13 patients underwent bidirectional superior cavopulmonary connection (stage 2 palliation) at an earlier age, 3.7 +/- 1.1 months of age versus 5.2 +/- 2.0 months for patients with an uncomplicated interstage course (P =.028). A growth curve was generated and showed reduced growth velocity between 4 and 5 months of age, with a plateau in growth beyond 5 months of age.

Conclusion: Daily home surveillance of arterial oxygen saturation according to pulse oximetry and weight selected patients at increased risk of interstage death, permitting timely intervention, primarily with early stage 2 palliation, and was associated with improved interstage survival. Diminished growth identified 4 to 5 months after the Norwood procedure brings into question the value of delaying stage 2 palliation beyond 5 months of age.

MeSH terms

  • Cardiac Surgical Procedures / methods*
  • Cardiac Surgical Procedures / mortality*
  • Continuity of Patient Care*
  • Female
  • Home Care Services, Hospital-Based*
  • Hospitals, Pediatric
  • Humans
  • Hypoplastic Left Heart Syndrome / mortality*
  • Hypoplastic Left Heart Syndrome / surgery*
  • Infant
  • Infant, Newborn
  • Male
  • Monitoring, Physiologic / methods*
  • Oximetry
  • Oxygen / blood*
  • Patient Discharge
  • Probability
  • Program Development
  • Reference Values
  • Risk Assessment
  • Risk Management
  • Survival Analysis
  • Survival Rate
  • Time Factors
  • Wisconsin / epidemiology


  • Oxygen