Impact of Reintervention During Stage 1 Palliation Hospitalization: A National, Multicenter Study

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Healthcare Quality Improvement

Background:

• Stage 1 palliation (S1P) for hypoplastic left heart syndrome (HLHS) is associated with significant morbidity and mortality.
• Previous studies have not fully captured the burden of reinterventions, particularly for patients hospitalized before Stage 2 palliation (S2P).
• This study aims to describe the rate of reintervention during S1P hospitalization and its impact on patient outcomes.

Purpose of the Study:

• To determine the rate of unplanned reinterventions following Stage 1 palliation in infants with hypoplastic left heart syndrome.
• To identify factors associated with the need for reintervention.
• To evaluate the impact of reintervention on postoperative complications, hospital discharge, and in-hospital mortality.

Main Methods:

• Analysis of a national cohort of participants enrolled in phase II of the National Pediatric Cardiology Quality Improvement Collaborative after S1P.
• Primary outcome: rate of reintervention (unplanned cardiac catheterization or surgical reoperation) during hospitalization after S1P and before S2P.
• Statistical analysis to identify factors associated with reintervention and compare outcomes between reintervention and non-reintervention groups.

Main Results:

• A total of 1367 participants underwent S1P, with 339 (24.8%) requiring reintervention.
• Factors associated with reintervention included gestational age, weight at S1P, atrioventricular septal defect, heterotaxy, preoperative pulmonary artery bands, hybrid S1P, and need for bypass or ECMO.
• The reintervention group had higher rates of postoperative complications, were less likely to be discharged before S2P (57.1% vs 86%), and had higher in-hospital mortality (17% vs 5%).

Conclusions:

• Unplanned reintervention after Stage 1 palliation occurs in approximately 25% of HLHS patients.
• Reintervention is associated with increased postoperative complications, prolonged inpatient status, and significantly reduced survival to Stage 2 palliation.
• These findings highlight the critical impact of reintervention on the outcomes of HLHS patients undergoing Stage 1 palliation.