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10. Association between Z-score for birth weight and postoperative outcomes in neonates and infants with congenital heart disease

Author

Steurer, Martina A, Peyvandi, Shabnam, Costello, John M, Moon-Grady, Anita J, Habib, Robert H, Hill, Kevin D, Jacobs, Marshall L, Jelliffe-Pawlowski, Laura L, Keller, Roberta L, Pasquali, Sara K, Reddy, Vadiyala M, Tabbutt, Sarah, and Rajagopal, Satish

Subjects
Heart Disease, Infant Mortality, Clinical Research, Perinatal Period - Conditions Originating in Perinatal Period, Preterm, Low Birth Weight and Health of the Newborn, Congenital Structural Anomalies, Pediatric, Cardiovascular, Patient Safety, 7.3 Management and decision making, Management of diseases and conditions, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, Reproductive health and childbirth, Good Health and Well Being, Birth Weight, Female, Fetal Growth Retardation, Heart Defects, Congenital, Humans, Infant, Infant, Newborn, Male, Postoperative Complications, Reference Values, Retrospective Studies, congenital heart disease, fetal growth restriction, Z-score for birth weight, postoperative outcomes, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Respiratory System
Abstract

ObjectiveWe hypothesized that infants with fetal growth restrictions have increased mortality and morbidity after congenital heart disease surgery.MethodsThe study included patients in The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010-2016) who underwent cardiac surgery at a corrected gestational age of ≤44 weeks. Patients were classified as severely (birth weight Z-score -4 to -2), moderately (Z-score -2 to -1), and mildly growth restricted (Z-score -1.0 to -0.5) and compared with a reference population (Z-score 0-0.5). Multivariable logistic regression clustering on center was used to evaluate the association of birth weight Z-score with operative mortality and postoperative complications and its interaction with gestational age was assessed.ResultsIn 25,244 patients, operative mortality was 8.6% and major complications occurred in 19.4%. Compared with the reference group, the adjusted odds ratio (AOR) of mortality was increased in infants with severe (AOR, 2.4; 95% confidence interval [CI], 2.0-3.0), moderate (AOR, 1.7; 95% CI, 1.4-2.0), and mild growth restriction (AOR, 1.4; 95% CI, 1.2-1.6). The AOR for major postoperative complications was increased for severe (AOR, 1.4; 95% CI, 1.2-1.7) and moderate growth restriction (AOR, 1.2; 95% CI, 1.1-1.4). There was significant interaction between birth weight Z-score and gestational age (P = .007).ConclusionsEven birth weight Z-scores slightly below average are independent risk factors for mortality and morbidity in infants who undergo cardiac surgery. The strongest association between poor fetal growth and operative mortality exists in early-term infants. These novel findings might account for some of the previously unexplained variation in cardiac surgical outcomes.

Published
2021

25. Abstract 12630: Association Between Z-score for Birth Weight and Postoperative Outcomes in Neonates and Infants With Congenital Heart Disease

Author

Steurer, Martina A, Peyvandi, Shabnam, Costello, John M, Moon-Grady, Anita J, Habib, Robert, Hill, Kevin D, Jacobs, Marshall L, Jelliffe-Pawlowski, Laura, Keller, Roberta, Pasquali, Sara K, Reddy, Vadiyala M, Tabbutt, Sarah, and rajagopal, satish

Subjects
Cardiovascular System & Hematology, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Public Health and Health Services
Abstract

Background: Neonates with congenital heart disease are more likely to be small for gestational age. Few studies have investigated the effect of birth weight Z-score on outcomes after congenital heart surgery. Methods: Patients from the Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2016) undergoing cardiac surgery at a corrected gestational age ≤ 44 weeks were included, and classified as severely (birth weight Z-score -4 to -2), moderately (Z-score between -2 and -1) and mildly growth restricted (Z-score -1.0 to -0.5) and compared to a reference (Z-score 0 to 0.5). Multivariable logistic regression clustering on center was used to evaluate the association of birth weight Z-score with operative mortality, postoperative complications and length of stay, adjusting for other patient characteristics. Interaction between Z-score for birth weight and gestational age was assessed. Results: In 25,244 patients, operative mortality was 8.6% and major complications occurred in 19.4%. Compared to the reference group with no growth restriction, the adjusted odds (AOR) of mortality was increased in infants with severe (AOR 2.4, CI 2.0-3.0), moderate (AOR 1.7, CI 1.4-2.0) and mild growth restriction (AOR 1.4, CI 1.2-1.6). The AOR for major postoperative complications was increased for infants with severe (AOR 1.4, CI 1.2-1.7) and moderate growth restriction (AOR 1.2, CI 1.1-1.4), but not in mildly growth restricted infants (AOR 1.0, CI 0.9-1.2). Length of stay was prolonged for all growth restricted cohorts (adjusted Hazard Ratio38 weeks) and then preterm infants (

Published
2020

35. Association of Volume and Outcomes in 234 556 Patients Undergoing Surgical Aortic Valve Replacement

Author

Thourani, Vinod H., Brennan, James M., Edelman, J. James, Thibault, Dylan, Jawitz, Oliver K., Bavaria, Joseph E., Higgins, Robert S.D., Sabik, Joseph F., III, Prager, Richard L., Dearani, Joseph A., MacGillivray, Thomas E., Badhwar, Vinay, Svensson, Lars G., Reardon, Michael J., Shahian, David M., Jacobs, Jeffrey P., Ailawadi, Gorav, Szeto, Wilson Y., Desai, Nimesh, Roselli, Eric E., Woo, Y. Joseph, Vemulapalli, Sreek, Carroll, John D., Yadav, Pradeep, Malaisrie, S. Chris, Russo, Mark, Nguyen, Tom C., Kaneko, Tsuyoshi, Tang, Gilbert, Ruel, Marc, Chikwe, Joanna, Lee, Richard, Habib, Robert H., George, Isaac, Leon, Martin B., and Mack, Michael J.

Published
2022
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48. Impact of Atrioventricular Valve Intervention at Each Stage of Single Ventricle Palliation

Author

Vossler, John D., Eckhauser, Aaron W., Griffiths, Eric R., Hobbs, Reilly D., Lambert, Linda M., Tani, Lloyd Y., Parsons, Niharika, Habib, Robert H., Jacobs, Jeffrey P., Jacobs, Marshall L., and Husain, S. Adil

Abstract

Background:Significant atrioventricular valve dysfunction can be associated with mortality or need for transplant in functionally univentricular heart patients undergoing staged palliation. The purposes of this study are to characterize the impact of concomitant atrioventricular valve intervention on outcomes at each stage of single ventricle palliation and to identify risk factors associated with poor outcomes in these patients. Methods:The Society of Thoracic Surgeons Congenital Heart Surgery Database was queried for functionally univentricular heart patients undergoing single ventricle palliation from 2013 through 2022. Separate analyses were performed on cohorts corresponding to each stage of palliation (1: initial palliation; 2: superior cavopulmonary anastomosis; 3: Fontan procedure). Bivariate analysis of demographics, diagnoses, comorbidities, preoperative risk factors, operative characteristics, and outcomes with and without concomitant atrioventricular valve intervention was performed. Multiple logistic regression was used to identify predictors associated with operative mortality or major morbidity. Results:Concomitant atrioventricular valve intervention was associated with an increased risk of operative mortality or major morbidity for each cohort (cohort 1: 62% vs 46%, P< .001; cohort 2: 37% vs 19%, P< .001; cohort 3: 22% vs 14%, P< .001). Black race in cohort 1 (odds ratio [OR] 3.151, 95% CI 1.181-9.649, P= .03) and preterm birth in cohort 2 (OR 1.776, 95% CI 1.049-3.005, P= .032) were notable predictors of worse morbidity or mortality. Conclusions:Concomitant atrioventricular valve intervention is a risk factor for operative mortality or major morbidity at each stage of single ventricle palliation. Several risk factors are associated with these outcomes and may be useful in guiding decision-making.

Published
2024
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