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, 8 (2), 135-141

Current Practices in the Timing of Stage 2 Palliation

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Current Practices in the Timing of Stage 2 Palliation

James M Meza et al. World J Pediatr Congenit Heart Surg.

Abstract

Background: Mortality through single-ventricle palliation remains high and the effect of the timing of stage 2 palliation (S2P) is not well understood. We investigated current practice patterns in the timing of S2P across two professional societies and compared them to actual practice patterns from two databases of patients who underwent S2P.

Methods: A ten-question survey was distributed to the members of the Congenital Heart Surgeons' Society (CHSS) and the European Congenital Heart Surgeons' Association (ECHSA). Results were summarized using descriptive statistics. Surgeon-reported preferences were compared to clinical data from the CHSS Critical Left Ventricular Outflow Tract Obstruction (LVOTO) Registry and the Pediatric Heart Network Single Ventricle Reconstruction (SVR) database.

Results: Overall, 38% (88 of 232) of surgeons from 74 institutions responded, of which 70% (62 of 88) were CHSS members and 30% (26 of 88) were ECHSA members. Surgeons reported performing S2P at a median of five months after stage 1 (interquartile range [IQR]: 4.5-6), with no difference between CHSS and ECHSA surgeons. Surgeons reported performing nonelective S2P at a median of 4.5 months after stage 1 (IQR: 3.5-5.5), again with no difference by society. No difference existed between the surgeon-reported preferences and patient data in the Critical LVOTO and SVR databases for the timing of elective (5 vs 5.1 vs 5.3 months, P = .19) or nonelective S2P (4.5 vs 4.6 vs 4.2 months, P = .06).

Conclusion: There was a remarkable lack of variation in surgeon preferences regarding the timing of S2P. This may represent a natural standardization of practice across congenital heart surgery, which is notable, given the current lack of guidelines regarding the timing of S2P.

Keywords: cavopulmonary anastamosis; congenital heart surgery; database; hypoplastic left heart syndrome.

Conflict of interest statement

Disclosures and Freedom of Investigation: The authors have no conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:
Survey of the current preferences in the timing of Stage-2-Palliation (S2P).
Figure 2:
Figure 2:
Box and whisker plots comparing the timing of “elective” S2P. Whiskers represent the minimum and maximum values within each data set while the edges of the boxes represent the 25th and 75th percentiles, respectively. The middle lines in the box represent the population median values. The diamonds represent mean values. The medians did not differ, p=0.19. CHSS=Congenital Heart Surgeons’ Society Critical Left Ventricular Outflow Tract Obstruction Registry, SVR=Single Ventricle Reconstruction Trial, Surgeon=Surgeon-reported preferences from the survey in this study
Figure 3:
Figure 3:
Box and whisker plots comparing the timing of “non-elective” S2P. Whiskers represent the extremes within each data set while the edges of the boxes represent the 25th and 75th percentiles, respectively. The middle lines in the box represent the population median values. The diamonds represent mean values. The medians nearly differed, p=0.06. CHSS=Congenital Heart Surgeons’ Society Critical Left Ventricular Outflow Tract Obstruction Registry, SVR=Single Ventricle Reconstruction Trial, Surgeon=Surgeon-reported preferences from the survey in this study

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