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Home surveillance program prevents interstage mortality after the Norwood procedure.

Publication ,  Journal Article
Ghanayem, NS; Hoffman, GM; Mussatto, KA; Cava, JR; Frommelt, PC; Rudd, NA; Steltzer, MM; Bevandic, SM; Frisbee, SS; Jaquiss, RDB; Litwin, SB ...
Published in: J Thorac Cardiovasc Surg
November 2003

OBJECTIVE: To determine whether early identification of physiologic variances associated with interstage death would reduce mortality, we developed a home surveillance program. METHODS: Patients discharged before initiation of home surveillance (group A, n = 63) were compared with patients discharged with an infant scale and pulse oximeter (group B, n = 24). Parents maintained a daily log of weight and arterial oxygen saturation according to pulse oximetry and were instructed to contact their physician in case of an arterial oxygen saturation less than 70% according to pulse oximetry, an acute weight loss of more than 30 g in 24 hours, or failure to gain at least 20 g during a 3-day period. RESULTS: Interstage mortality among infants surviving to discharge was 15.8% (n = 9/57) in group A and 0% (n = 0/24) in group B (P =.039). Surveillance criteria were breached for 13 of 24 group B patients: 12 patients with decreased arterial oxygen saturation according to pulse oximetry with or without poor weight gain and 1 patient with poor weight gain alone. These 13 patients underwent bidirectional superior cavopulmonary connection (stage 2 palliation) at an earlier age, 3.7 +/- 1.1 months of age versus 5.2 +/- 2.0 months for patients with an uncomplicated interstage course (P =.028). A growth curve was generated and showed reduced growth velocity between 4 and 5 months of age, with a plateau in growth beyond 5 months of age. CONCLUSION: Daily home surveillance of arterial oxygen saturation according to pulse oximetry and weight selected patients at increased risk of interstage death, permitting timely intervention, primarily with early stage 2 palliation, and was associated with improved interstage survival. Diminished growth identified 4 to 5 months after the Norwood procedure brings into question the value of delaying stage 2 palliation beyond 5 months of age.

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Published In

J Thorac Cardiovasc Surg

DOI

ISSN

0022-5223

Publication Date

November 2003

Volume

126

Issue

5

Start / End Page

1367 / 1377

Location

United States

Related Subject Headings

  • Wisconsin
  • Ventricular Dysfunction, Right
  • Ultrasonography, Doppler, Transcranial
  • Treatment Outcome
  • Tomography, Emission-Computed
  • Time Factors
  • Suture Techniques
  • Survival Rate
  • Survival Analysis
  • Sensitivity and Specificity
 

Citation

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Ghanayem, N. S., Hoffman, G. M., Mussatto, K. A., Cava, J. R., Frommelt, P. C., Rudd, N. A., … Tweddell, J. S. (2003). Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg, 126(5), 1367–1377. https://doi.org/10.1016/s0022-5223(03)00071-0
Ghanayem, N. S., G. M. Hoffman, K. A. Mussatto, J. R. Cava, P. C. Frommelt, N. A. Rudd, M. M. Steltzer, et al. “Home surveillance program prevents interstage mortality after the Norwood procedure.J Thorac Cardiovasc Surg 126, no. 5 (November 2003): 1367–77. https://doi.org/10.1016/s0022-5223(03)00071-0.
Ghanayem NS, Hoffman GM, Mussatto KA, Cava JR, Frommelt PC, Rudd NA, et al. Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg. 2003 Nov;126(5):1367–77.
Ghanayem, N. S., et al. “Home surveillance program prevents interstage mortality after the Norwood procedure.J Thorac Cardiovasc Surg, vol. 126, no. 5, Nov. 2003, pp. 1367–77. Pubmed, doi:10.1016/s0022-5223(03)00071-0.
Ghanayem NS, Hoffman GM, Mussatto KA, Cava JR, Frommelt PC, Rudd NA, Steltzer MM, Bevandic SM, Frisbee SS, Jaquiss RDB, Litwin SB, Tweddell JS. Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg. 2003 Nov;126(5):1367–1377.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

ISSN

0022-5223

Publication Date

November 2003

Volume

126

Issue

5

Start / End Page

1367 / 1377

Location

United States

Related Subject Headings

  • Wisconsin
  • Ventricular Dysfunction, Right
  • Ultrasonography, Doppler, Transcranial
  • Treatment Outcome
  • Tomography, Emission-Computed
  • Time Factors
  • Suture Techniques
  • Survival Rate
  • Survival Analysis
  • Sensitivity and Specificity