Quantifying Additional Procedures in Functionally Single-Ventricle Disease: A National Cohort Study.

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease Research
• Health Services Research

Background:

• Congenital heart disease (CHD) affects many children, with functionally single-ventricle (f-SV) conditions requiring complex staged palliation.
• Reintervention rates are crucial metrics for evaluating healthcare quality in pediatric CHD management.
• Understanding reintervention patterns informs clinical practice and patient outcomes.

Purpose of the Study:

• To evaluate the rates of surgical and catheter reinterventions in children with f-SV CHD.
• To assess the incidence of additional procedures following staged palliation for f-SV CHD.
• To provide data for improving care and developing interventions for f-SV CHD.

Main Methods:

• Retrospective cohort study of children born with f-SV CHD (2000-2018) in England and Wales.
• Utilized national registry data with survival ascertained up to 2020.
• Employed competing risk analysis to determine the incidence of additional procedures, accounting for death or transplantation.

Main Results:

• Of 3307 children with f-SV CHD, 27.9% required additional surgery and 39.1% needed catheter interventions during follow-up.
• Cumulative incidence of additional surgery was 17.6% at 6 months post-stage 1, 8.3% at 2 years post-stage 2, and 8.4% at 5 years post-stage 3.
• Cumulative incidence of additional catheter interventions was 18.0% at 6 months post-stage 1, 14.7% at 2 years post-stage 2, and 23.7% at 5 years post-stage 3.

Conclusions:

• Quantifying reintervention rates is essential for informing parents and healthcare professionals involved in f-SV CHD care.
• The study highlights a significant need for interventions aimed at reducing reinterventions in this population.
• Further research should focus on strategies to minimize adverse outcomes associated with staged palliation for f-SV CHD.