Clinical and haemodynamic variables associated with intensive care unit length of stay and early adverse outcomes after the Norwood procedure. (28th January 2022)

• Record Type: Journal Article
• Authors: Staehler, Helena; Ono, Masamichi; Schober, Patrick; Kido, Takashi; Heinisch, Paul Philipp; Strbad, Martina; Vodiskar, Janez; Cleuziou, Julie; Lemmer, Julia; Balling, Gunter; Hager, Alfred; Ewert, Peter; Hörer, Jürgen
• Is Part Of: European journal of cardio-thoracic surgery. Volume 61:Number 6(2022)
• Page Start: 1271
• Page End: 1280
• Publication Date: 2022-01-28
• Subjects: Hypoplastic left heart syndrome -- Intensive care unit -- Length of stay -- Mortality -- Adverse events; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezac014
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: This study was performed to determine the clinical and haemodynamic variables associated with early adverse outcomes after the neonatal Norwood procedure. METHODS: Patients who underwent the neonatal Norwood procedure between 2001 and 2019 were included. The patient diagnosis, morphological characteristics and haemodynamic parameters were analysed to identify factors associated with length of stay (LOS) in the intensive care unit (ICU) and mortality during the stay. RESULTS: A total of 322 patients were depicted. The median age and weight at the Norwood procedure were 9 days and 3.2 kg, respectively. Certain morphological and preoperative parameters, such as birth weight below 2.5 kg, restrictive atrial septal defect, extracardiac anomalies and the diameter of the ascending aorta, were found to be associated with the LOS in the ICU. Analysis using early postoperative haemodynamic variables revealed that systolic arterial pressure, diastolic arterial pressure, serum lactate levels and reduced ventricular function at 2 days postoperatively were associated with the LOS in the ICU. Birth weight <2.5 kg ( P = 0.010), a restrictive atrial septal defect ( P = 0.001) and smaller ascending aorta ( P = 0.039) were associated with death in the ICU. Reduced ventricular function, lower systolic aortic pressure and higher lactate levels at various time points ( P < 0.05) were also associated with ICU deaths. The LOS in the ICU was significantly associated with late mortality ( P < 0.001, Hazard Ratio (HR) = 1.015). CONCLUSIONS: The LOS in the ICU after the Norwood procedure was predicted by early postoperative haemodynamic variables, suggesting that good early postoperative haemodynamics determine early recovery. A prolonged stay in the ICU after the Norwood procedure was associated with late mortality. Abstract : During the past 3 decades, three-stage palliation starting with the neonatal Norwood procedure has been the most common surgical strategy for treating hypoplastic left heart syndrome (HLHS) and its variants [1–3].