Boston - American Association for Thoracic Surgery

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89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS53. Impact of Comprehensive Perioperative and Interstage Monitoringon Survival in High-Risk Infants After Stage 1 Palliation ofUniventricular Heart DiseaseNancy S. Ghanayem, 1 Kathleen A. Mussatto, 2 George M. Hoffman, 1Michael E. Mitchell, 1 Michele A. Frommelt, 1 Joseph R. Cava, 1James S. Tweddell 1*1. Medical College of Wisconsin, Milwaukee, WI, USA; 2. Children’s Hospital ofWisconsin, Milwaukee, WI, USAInvited Discussant: J.W. GaynorOBJECTIVE: Survival after Norwood palliation for high-risk patients withuniventricular congenital heart disease is reduced compared to standard-riskpatients. We hypothesized that early goal directed monitoring with venous oximetryand near infrared spectroscopy, and noninvasive interstage monitoring, would offsetthe increased vulnerability of high-risk patients and improve survival.METHODS: An IRB-approved prospective database of patients with univentricularcardiac defects undergoing stage 1 palliation was used to study outcomes sinceincorporation of a comprehensive goal-directed monitoring program. Patients wereconsidered high-risk if ≤35 weeks gestation, birth weight
AMERICAN ASSOCIATION FOR THORACIC SURGERYbetween groups: 97% (38/39) in high-risk versus 97% (119/123) in standard-risk.Survival to stage 2 palliation was 87.2% (34/39) in high-risk versus 93.5% (115/123)in low risk groups, p = 0.2. High-risk patients discharged from ICU were morelikely to require inpatient treatment until stage 2 palliation: 26% (9/34) versus 10%(12/118), p = 0.003, although age at stage 2 palliation was not different (126 ± 33days versus 116 ± 38 days, p = 0.2). High-risk patients had lower 1 year survival(76% versus 93%, p = 0.001) and survival to date (72% versus 92%, p = 0.004).CONCLUSION: With an intensive monitoring strategy, identical high early survivalwas achieved in both patient risk strata. Prolonged interstage hospitalizationfor intensive non-invasive monitoring in high-risk patients until stage 2 palliationconferred similar survival to standard-risk patients monitored at home. Mortalitybeyond stage 2 palliation when level of monitoring is reduced is a relatively uniquefeature of high risk patients. Although mortality is reduced with enhanced monitoring,high resource utilization and late attrition of high-risk patients after stage 2palliation suggests an ongoing need to evaluate our current palliative strategy for asubset of patients with univentricular heart disease.5:00 p.m. EXECUTIVE SESSION(AATS Members Only)Ballroom A–C, Hynes Convention CenterTUESDAYAfternoon195
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Boston - American Association for Thoracic Surgery

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