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Interstage Weight Gain Is Associated With Survival After First-Stage Single-Ventricle Palliation
Charles F Evans1, John D Sorkin2, Danielle S Abraham3
1Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
Insights
Weight gain after initial single-ventricle palliation surgery is crucial for survival. Greater weight gain in infants is linked to improved transplant-free survival rates before the next stage of surgery.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
Background:
- Low birth weight and operative weight are known risk factors for mortality following first-stage single-ventricle palliation.
- Interstage mortality remains a significant concern in single-ventricle physiology management.
Purpose of the Study:
- To investigate the association between weight gain during the interstage period and transplant-free survival.
- To determine if increased weight post-first-stage palliation improves outcomes before second-stage surgery.
Main Methods:
- A longitudinal study using the National Pediatric Cardiology Quality Improvement Collaborative database.
- Inclusion of 1,501 infants discharged after first-stage single-ventricle palliation (excluding hybrid procedures and loss to follow-up).
- Repeated-measures logistic regression utilizing the generalized estimating equation method to analyze weight gain and transplant-free survival.
Main Results:
- Transplant-free interstage survival was 90% (1,228/1,358 infants).
- Mean weight gain was 2.5 kg (SD, 1.0 kg).
- Each 100g increase in weight was associated with a 1.03 odds ratio for transplant-free survival (95% CI, 1.01-1.05), after adjusting for multiple clinical factors.
Conclusions:
- Interstage weight gain is a significant positive predictor of transplant-free survival after first-stage single-ventricle palliation.
- Monitoring and promoting adequate weight gain in the interstage period may be vital for improving outcomes.
Background:
Low birth and operative weight have been identified as risk factors for death after first-stage single-ventricle palliation. We hypothesize that weight gain after the first-stage operation is associated with transplant-free interstage survival to admission for the second-stage operation.
Methods:
We used historical data from the National Pediatric Cardiology Quality Improvement Collaborative database to conduct a longitudinal study to assess the association between weight gain and transplant-free interstage survival. The primary predictor was weight gain. The primary outcome was transplant-free survival. We constructed a repeated-measures logistic regression model using the general estimating equation method to examine the association between weight gain and transplant-free interstage survival.
Results:
The study population included 1,501 infants who were discharged alive from the first-stage single-ventricle palliation between June 2008 and January 2015. Patients who underwent a hybrid operation (n = 132) or were lost to follow-up (n = 11) were excluded. Transplant-free interstage survival was 90% (1,228 of 1,358). The mean weight gain was 2.5 (SD, 1.0) kg. Adjusted for age at the time of each measurement, the number of measurements, age at discharge from the first-stage operation, sex, diagnosis, postoperative arrhythmia, postoperative complications, and discharge antibiotic therapy, each 100-g increase in weight was associated with an odds ratio of transplant-free interstage survival of 1.03 (95% confidence limit, 1.01, 1.05).
Conclusions:
After first-stage single-ventricle palliation, interstage weight gain is significantly associated with transplant-free interstage survival.
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