Risk Factors and Outcomes for Post-operative Arrhythmias Following the Norwood Operation

Area of Science:

• Pediatric Cardiology
• Cardiac Surgery
• Critical Care Medicine

Background:

• Single ventricle heart disease requires staged palliation, with the Norwood operation being the first stage.
• The interstage period after the Norwood operation carries significant morbidity and mortality.
• Post-operative arrhythmias are frequent but their risk factors and impact are not well understood.

Purpose of the Study:

• To identify risk factors for post-operative arrhythmias following the Norwood operation.
• To evaluate the clinical outcomes and impact of these arrhythmias on patient morbidity and mortality.

Main Methods:

• Retrospective cohort study of neonates undergoing the Norwood operation (2010-2023).
• Identification of clinically significant arrhythmias requiring intervention.
• Analysis of demographic, intraoperative, and postoperative variables.
• Multivariable logistic regression to assess associations with arrhythmias and operative mortality.

Main Results:

• Arrhythmias occurred in 33.2% of 322 patients, most commonly supraventricular tachycardias.
• Younger age at surgery and acute kidney injury were associated with arrhythmias.
• Arrhythmias correlated with longer ICU and hospital stays.
• Operative mortality was 18.3%, not independently predicted by arrhythmias.

Conclusions:

• Clinically significant arrhythmias are common after the Norwood operation.
• Younger age and acute kidney injury are risk factors for arrhythmias.
• Arrhythmias increase morbidity but are not independent predictors of operative mortality.