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Association of a Home Monitoring Program With Interstage and Stage 2 Outcomes

BACKGROUND: In shunt‐dependent, single‐ventricle patients, mortality remains high in the interstage period between discharge after neonatal surgery and stage 2 operation. We sought to evaluate the impact of our infant single‐ventricle management and monitoring program (ISVMP) on interstage mortality...

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Autores principales: Gardner, Monique M., Mercer‐Rosa, Laura, Faerber, Jennifer, DiLorenzo, Michael P., Bates, Katherine E., Stagg, Alyson, Natarajan, Shobha S., Szwast, Anita, Fuller, Stephanie, Mascio, Christopher E., Fleck, Desiree, Torowicz, Deborah L., Giglia, Therese M., Rome, Jonathan J., Ravishankar, Chitra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585324/
https://www.ncbi.nlm.nih.gov/pubmed/31112448
http://dx.doi.org/10.1161/JAHA.118.010783
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author Gardner, Monique M.
Mercer‐Rosa, Laura
Faerber, Jennifer
DiLorenzo, Michael P.
Bates, Katherine E.
Stagg, Alyson
Natarajan, Shobha S.
Szwast, Anita
Fuller, Stephanie
Mascio, Christopher E.
Fleck, Desiree
Torowicz, Deborah L.
Giglia, Therese M.
Rome, Jonathan J.
Ravishankar, Chitra
author_facet Gardner, Monique M.
Mercer‐Rosa, Laura
Faerber, Jennifer
DiLorenzo, Michael P.
Bates, Katherine E.
Stagg, Alyson
Natarajan, Shobha S.
Szwast, Anita
Fuller, Stephanie
Mascio, Christopher E.
Fleck, Desiree
Torowicz, Deborah L.
Giglia, Therese M.
Rome, Jonathan J.
Ravishankar, Chitra
author_sort Gardner, Monique M.
collection PubMed
description BACKGROUND: In shunt‐dependent, single‐ventricle patients, mortality remains high in the interstage period between discharge after neonatal surgery and stage 2 operation. We sought to evaluate the impact of our infant single‐ventricle management and monitoring program (ISVMP) on interstage mortality and stage 2 outcomes. METHODS AND RESULTS: This retrospective single‐center cohort study compared patients enrolled in ISVMP at hospital discharge with historical controls. The relationship of ISVMP to interstage mortality was determined with a bivariate probit model for the joint modeling of both groups, using an instrumental variables approach. We included 166 ISVMP participants (December 1, 2010, to June 30, 2015) and 168 controls (January 1, 2007, to November 30, 2010). The groups did not differ by anatomy, gender, race, or genetic syndrome. Mortality was lower in the ISVMP group (5.4%) versus controls (13%). An ISVMP infant compared with a historical control had an average 29% lower predicted probability of interstage death (adjusted probability: −0.29; 95% CI, −0.52 to −0.057; P=0.015). On stratified analysis, mortality was lower in the hypoplastic left heart syndrome subgroup undergoing Norwood operation (4/84 [4.8%] versus 12/90 [14%], P=0.03) but not in those with initial palliation of shunt only (P=0.90). ISVMP participants were younger at the time of the stage 2 operation (138 versus 160 days, P<0.001), with no difference in postoperative mortality or length of stay. CONCLUSIONS: In this single‐center study, we report significantly lower interstage mortality for participants with hypoplastic left heart syndrome enrolled in ISVMP. Younger age at stage 2 operation was not associated with postoperative mortality or longer length of stay.
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spelling pubmed-65853242019-06-27 Association of a Home Monitoring Program With Interstage and Stage 2 Outcomes Gardner, Monique M. Mercer‐Rosa, Laura Faerber, Jennifer DiLorenzo, Michael P. Bates, Katherine E. Stagg, Alyson Natarajan, Shobha S. Szwast, Anita Fuller, Stephanie Mascio, Christopher E. Fleck, Desiree Torowicz, Deborah L. Giglia, Therese M. Rome, Jonathan J. Ravishankar, Chitra J Am Heart Assoc Original Research BACKGROUND: In shunt‐dependent, single‐ventricle patients, mortality remains high in the interstage period between discharge after neonatal surgery and stage 2 operation. We sought to evaluate the impact of our infant single‐ventricle management and monitoring program (ISVMP) on interstage mortality and stage 2 outcomes. METHODS AND RESULTS: This retrospective single‐center cohort study compared patients enrolled in ISVMP at hospital discharge with historical controls. The relationship of ISVMP to interstage mortality was determined with a bivariate probit model for the joint modeling of both groups, using an instrumental variables approach. We included 166 ISVMP participants (December 1, 2010, to June 30, 2015) and 168 controls (January 1, 2007, to November 30, 2010). The groups did not differ by anatomy, gender, race, or genetic syndrome. Mortality was lower in the ISVMP group (5.4%) versus controls (13%). An ISVMP infant compared with a historical control had an average 29% lower predicted probability of interstage death (adjusted probability: −0.29; 95% CI, −0.52 to −0.057; P=0.015). On stratified analysis, mortality was lower in the hypoplastic left heart syndrome subgroup undergoing Norwood operation (4/84 [4.8%] versus 12/90 [14%], P=0.03) but not in those with initial palliation of shunt only (P=0.90). ISVMP participants were younger at the time of the stage 2 operation (138 versus 160 days, P<0.001), with no difference in postoperative mortality or length of stay. CONCLUSIONS: In this single‐center study, we report significantly lower interstage mortality for participants with hypoplastic left heart syndrome enrolled in ISVMP. Younger age at stage 2 operation was not associated with postoperative mortality or longer length of stay. John Wiley and Sons Inc. 2019-05-21 /pmc/articles/PMC6585324/ /pubmed/31112448 http://dx.doi.org/10.1161/JAHA.118.010783 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Gardner, Monique M.
Mercer‐Rosa, Laura
Faerber, Jennifer
DiLorenzo, Michael P.
Bates, Katherine E.
Stagg, Alyson
Natarajan, Shobha S.
Szwast, Anita
Fuller, Stephanie
Mascio, Christopher E.
Fleck, Desiree
Torowicz, Deborah L.
Giglia, Therese M.
Rome, Jonathan J.
Ravishankar, Chitra
Association of a Home Monitoring Program With Interstage and Stage 2 Outcomes
title Association of a Home Monitoring Program With Interstage and Stage 2 Outcomes
title_full Association of a Home Monitoring Program With Interstage and Stage 2 Outcomes
title_fullStr Association of a Home Monitoring Program With Interstage and Stage 2 Outcomes
title_full_unstemmed Association of a Home Monitoring Program With Interstage and Stage 2 Outcomes
title_short Association of a Home Monitoring Program With Interstage and Stage 2 Outcomes
title_sort association of a home monitoring program with interstage and stage 2 outcomes
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585324/
https://www.ncbi.nlm.nih.gov/pubmed/31112448
http://dx.doi.org/10.1161/JAHA.118.010783
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