New approach to interstage care for palliated high-risk patients with congenital heart disease

J Thorac Cardiovasc Surg. 2011 Oct;142(4):855-60. doi: 10.1016/j.jtcvs.2011.01.054. Epub 2011 Mar 12.


Objective: Home surveillance monitoring might identify patients at risk for interstage death after stage 1 palliation for hypoplastic left heart syndrome. We sought to identify the effect that a high-risk program might have on interstage mortality and identification of residual/recurrent lesions after neonatal palliative operations.

Methods: Between January 2006 to January 2010, newborns after stage 1 palliation for hypoplastic left heart syndrome or shunt placement were invited to participate in our high-risk program. Patients enrolled in our high-risk program comprise the study group. Patients who had similar operations between January 2002 and December 2005 comprise the control group. Comparisons are made between the 2 groups with respect to interstage mortality and the frequency and timing of interstage admissions requiring medical, catheter, or surgical treatment.

Results: Seventy-two patients met the criteria for our high-risk program. Fifty-nine (82%) of 72 patients were enrolled. Among 19 patients with hypoplastic left heart syndrome in our high-risk program, outpatient interstage mortality was zero. Outpatient interstage mortality for the 36 control subjects with hypoplastic left heart syndrome was 6%. Among 40 patients with shunts in the study group, there was 1 outpatient interstage death compared with 4 (6%) deaths in 68 subjects in the control group. Significant residual/recurrent lesions were identified with similar frequency between the 2 groups. However, after shunt operations, these lesions were detected and treated at significantly younger mean ages for patients followed in the high-risk program (P < .005).

Conclusions: Initiation of a high-risk program might decrease interstage mortality after high-risk neonatal palliative operations. Such an approach might contribute to earlier detection of significant residual/recurrent lesions amenable to therapy.

MeSH terms

  • Cardiac Surgical Procedures* / adverse effects
  • Cardiac Surgical Procedures* / mortality
  • Case-Control Studies
  • Chi-Square Distribution
  • Female
  • Florida
  • Health Knowledge, Attitudes, Practice
  • Home Care Services, Hospital-Based* / standards
  • Humans
  • Hypoplastic Left Heart Syndrome / mortality
  • Hypoplastic Left Heart Syndrome / surgery*
  • Infant Formula
  • Infant Mortality
  • Infant Nutritional Physiological Phenomena
  • Infant, Newborn
  • Male
  • Medical Records Systems, Computerized
  • Nutritional Status
  • Oximetry
  • Palliative Care
  • Postoperative Complications / diagnosis
  • Postoperative Complications / mortality
  • Postoperative Complications / therapy*
  • Program Evaluation
  • Quality Improvement
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Weight Gain