Interstage weight gain for patients with hypoplastic left heart syndrome undergoing the hybrid procedure.

BACKGROUND Weight gain during the interstage (IS) period for hypoplastic left heart (HLHS) patients has been associated with improved outcomes. IS home monitoring has been shown to improve mortality. No data exist on IS weight gain and home monitoring effects on weight gain for HLHS patients undergoing the hybrid procedure. OBJECTIVE Goal of this study was to describe the weight gain of patients with HLHS undergoing the hybrid procedure during the IS period, to determine if weight parameters were associated with mortality, and to determine if home monitoring improved weight gain. METHODS Retrospective review was performed. Patients were included if they had the diagnosis of HLHS and underwent hybrid procedure. Baseline demographics, surgical dates, and all IS weights were recorded. RESULTS Forty-four patients met inclusion criteria, 24 patients had IS monitoring. Time period evaluated was from April 2006 to June 2011. Mean birth weight of the total population was 3.13 ± 0.61 kg, age at hybrid was 5.84 ± 4.10 days, weight z-score at hybrid discharge was -1.66 ± 1.01, age at pre-Stage II was 6.12 ± 1.37 months, IS weight gain was 16.85 ± 5.94 g/day, and weight z-score pre-Stage II was -2.25 ± 1.28. Monitored patients had significantly higher weight z-score pre-Stage II (-1.67 ± 0.98 vs. -2.82 ± 1.28) and lower change in weight z-score (-0.26 ± 0.97 vs. -1.24 ± 1.06). Eight patients died IS. There was a significant difference in weight gain per day in those that survived the IS period (17.87 ± 4.75 g/day vs. 12.28 ± 8.65 g/day). There were no significant differences in weight characteristics in patients that survived the Stage II procedure (n = 28) vs. those that did not (n = 7). CONCLUSION Home monitoring improved IS weight gain in patients undergoing the hybrid procedure. Decreased weight gain per day was associated with IS mortality.

[1]  Richard V. Williams,et al.  Variation in growth of infants with a single ventricle. , 2012, The Journal of pediatrics.

[2]  P. Kirshbom,et al.  Impact of early fundoplication or gastrostomy tube on midterm outcomes for patients with single ventricle. , 2012, The Journal of thoracic and cardiovascular surgery.

[3]  C. Fraser,et al.  The impact of a dedicated single-ventricle home-monitoring program on interstage somatic growth, interstage attrition, and 1-year survival. , 2011, The Journal of thoracic and cardiovascular surgery.

[4]  N. Ghanayem,et al.  Feeding, growth, nutrition, and optimal interstage surveillance for infants with hypoplastic left heart syndrome , 2011, Cardiology in the Young.

[5]  M. Stylianou,et al.  Factors affecting growth in infants with single ventricle physiology: a report from the Pediatric Heart Network Infant Single Ventricle Trial. , 2011, The Journal of pediatrics.

[6]  P. Eghtesady,et al.  Low weight-for-age z-score and infection risk after the Fontan procedure. , 2011, The Annals of thoracic surgery.

[7]  R. Sachdeva,et al.  Impact of staged palliation on somatic growth in patients with hypoplastic left heart syndrome. , 2010, Congenital heart disease.

[8]  P. Eghtesady,et al.  Predictors of poor weight gain in infants with a single ventricle. , 2010, The Journal of pediatrics.

[9]  J. Cheatham,et al.  The retrograde aortic arch in the hybrid approach to hypoplastic left heart syndrome. , 2009, The Annals of thoracic surgery.

[10]  P. Eghtesady,et al.  Lower weight-for-age z score adversely affects hospital length of stay after the bidirectional Glenn procedure in 100 infants with a single ventricle. , 2009, Journal of Thoracic and Cardiovascular Surgery.

[11]  J. Cheatham,et al.  Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. , 2008, The Annals of thoracic surgery.

[12]  C. Pizarro,et al.  Improving the outcome of high-risk neonates with hypoplastic left heart syndrome: hybrid procedure or conventional surgical palliation? , 2008, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[13]  I. Michel-Behnke,et al.  Hybrid Transcatheter–Surgical Palliation , 2007, Pediatric Cardiology.

[14]  A. Teixeira-Pinto,et al.  Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. , 2006, Nutrition.

[15]  M. Fisberg,et al.  Serum albumin and clinical outcome in pediatric cardiac surgery. , 2005, Nutrition.

[16]  J. Cheatham,et al.  Lessons Learned from the Development of a New Hybrid Strategy for the Management of Hypoplastic Left Heart Syndrome , 2005, Pediatric Cardiology.

[17]  J. Tweddell,et al.  Home monitoring of infants after stage one palliation for hypoplastic left heart syndrome. , 2004, Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual.

[18]  K. Mussatto,et al.  Home surveillance program prevents interstage mortality after the Norwood procedure. , 2003, The Journal of thoracic and cardiovascular surgery.