Congenital heart disease
Variation in perioperative care across centers for infants undergoing the Norwood procedure

https://doi.org/10.1016/j.jtcvs.2012.05.021Get rights and content
Under an Elsevier user license
open archive

Objectives

In the Single Ventricle Reconstruction trial, infants undergoing the Norwood procedure were randomly allocated to undergo a right ventricle-to-pulmonary artery shunt or a modified Blalock-Taussig shunt. Apart from shunt type, subjects received the local standard of care. We evaluated variation in perioperative care during the Norwood hospitalization across 14 trial sites.

Methods

Data on preoperative, operative, and postoperative variables for 546 enrolled subjects who underwent the Norwood procedure were collected prospectively on standardized case report forms, and variation across the centers was described.

Results

Gestational age, birth weight, and proportion with hypoplastic left heart syndrome were similar across sites. In contrast, all recorded variables related to preoperative care varied across centers, including fetal diagnosis (range, 55%-85%), preoperative intubation (range, 29%-91%), and enteral feeding. Perioperative and operative factors were also variable across sites, including median total support time (range, 74-189 minutes) and other perfusion variables, arch reconstruction technique, intraoperative medication use, and use of modified ultrafiltration (range, 48%-100%). Additional variation across centers was seen in variables related to postoperative care, including proportion with an open sternum (range, 35%-100%), median intensive care unit stay (range, 9-44 days), type of feeding at discharge, and enrollment in a home monitoring program (range, 1%-100%; 5 sites did not have a program). Overall, in-hospital death or transplant occurred in 18% (range across sites, 7%-39%).

Conclusions

Perioperative care during the Norwood hospitalization varies across centers. Further analysis evaluating the underlying causes and relationship of this variation to outcome is needed to inform future studies and quality improvement efforts.

CTSNet classification

4.4
20

Abbreviations and Acronyms

DHCA
deep hypothermic cardiac arrest
ICU
intensive care unit
IQR
interquartile range
RCP
regional cerebral perfusion
SVR
Single Ventricle Reconstruction [trial]

Cited by (0)

Supported by grants HL068269, HL068270, HL068279, HL068281, HL068285, HL068288, HL068290, HL068292, and HL085057 from the National Heart, Lung, and Blood Institute. S.K.P. receives grant support from the National Heart, Lung, and Blood Institute (1K08HL103631-01) and from the American Heart Association Mid-Atlantic Affiliate Clinical Research Program. The contents of this work are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health and National Heart, Lung, and Blood Institute. ClinicalTrials.gov number, NCT00115934.

Disclosures: Authors have nothing to disclose with regard to commercial support.

See Appendix for a complete list of members of the Pediatric Heart Network Investigators.