Risk Factors and Outcomes for Infants Requiring Unplanned Reintervention After Stage 2 Palliation for Single-Ventricle Heart Disease.

Abstract

Previous studies identified unplanned reintervention after stage 1 palliation for single-ventricle heart disease to be associated with increased morbidity and worse long-term outcomes. However, the impact of unplanned reinterventions after stage 2 palliation is unclear. We describe risk factors associated with stage 2 unplanned reintervention and its impact on outcomes. Using the National Pediatric Cardiology Quality Improvement Collaborative database, multivariate regression models identified risk factors for undergoing an unplanned reintervention and associated outcomes. Of 2095 patients who underwent stage 2 palliation, 401 (19.1%) patients had an unplanned reintervention: 247 (11.8%), interventional catheterization only; 78 (3.7%), surgery only; and 76 (3.6%), both catheterization and surgical reintervention. Risk factors for unplanned reintervention included hybrid as stage 1 (odds ratio [OR], 1.8; 95% CI, 1.1-3.1), reintervention after stage 1, tube feedings at stage 2 (OR, 1.9; 95% CI, 1.4-2.5), and additional cardiac procedures during stage 2 surgery (OR, 1.9; 95% CI, 1.5-2.5). Patients who underwent both surgical and catheterization reinterventions experienced a median 21-day longer stay (95% CI, 14.5-27.5 days) and underwent additional reinterventions between stage 2 discharge and first birthday (OR, 3.8; 95% CI, 2.0-7.2). Receiving any reintervention was associated with decreased transplant-free survival (hazard ratio, 2.2; 95% CI, 1.4-3.5). Unplanned reinterventions after stage 2 are associated with increased morbidity including longer hospital length of stay, future interventions, and decreased transplant-free survival. Certain identified risk factors may be modifiable targets for efforts to improve outcomes.