Risk factors for prolonged length of stay after the stage 2 procedurein the single-ventricle reconstruction trialSteven M. Schwartz, MD, a Minmin Lu, MS, b Richard G. Ohye, MD, c Kevin D. Hill, MD, dAndrewM.Atz,MD, e MaryamY.Naim,MD, f IsmeeA.Williams,MD,MS, g CarenS.Goldberg,MD,MS, hAlan Lewis, MD, i Frank Pigula, MD, j Peter Manning, MD, k Christian Pizarro, MD, l Paul Chai, MD, mRachel McCandless, MD, n Carolyn Dunbar-Masterson, BSN, o Jonathan R. Kaltman, MD, pKirk Kanter, MD, q Lynn A. Sleeper, ScD, b Julie V. Schonbeck, MSN, C-PNP, b and Nancy Ghanayem, MD, rfor the Pediatric Heart Network InvestigatorsBackground: The single-ventricle reconstruction trial randomized patients with single right ventricle lesions toamodifiedBlalock-Taussigorrightventricle-to-pulmonary artery shunt atthe Norwood. This analysisdescribesoutcomes at the stage 2 procedure and factors associated with a longer hospital length of stay (LOS).Methods: We examined the association of shunt type with stage 2 hospital outcomes. Cox regression andbootstrapping were used to evaluate risk factors for longer LOS. We also examined characteristics associatedwith in-hospital death.Results: There were 393 subjects in the analytic cohort. Median stage 2 procedure hospital LOS (8 days;interquartile range [IQR], 6-14 days), hospital mortality (4.3%), transplantation (0.8%), median ventilatortime (2 days; IQR, 1-3 days), median intensive care unit LOS (4 days; IQR, 3-7 days), number of additionalcardiac procedures or complications, and serious adverse events did not differ by shunt type. Longer LOSwas associated (R 2 ¼ 0.26) with center, longer post-Norwood LOS (hazard ratio [HR], 1.93 per log day;P<.001), nonelective timing of the stage 2 procedure (HR, 1.78; P<.001), and pulmonary artery (PA) stenosis(HR, 1.56; P<.001). By univariate analysis, nonelective stage 2 (65% vs 32%; P ¼ .009), moderate or greateratrioventricular valve (AVV) regurgitation (75% vs 24%; P<.001), and AVV repair (53% vs 9%; P<.001)were among the risk factors associated with in-hospital death.Conclusions: Norwood LOS, PA stenoses, and nonelective stage 2 procedure, but not shunt type, are indepen-dently associated with longer LOS. Nonelective stage 2 procedure, moderate or greater AVV regurgitation, andneed for AVV repair are among the risk factors for death. (J Thorac Cardiovasc Surg 2014;147:1791-8)Supplemental material is available online.Staged surgical repair for hypoplastic left heart syndrome(HLHS) and other single right ventricle anomalies usuallyincludes a stage 2 procedure (superior cavopulmonaryconnection) between the Norwood and Fontan procedures(total cavopulmonary connection). This approach reducesmorbidity and mortality at the time of the Fontanprocedure 1,2 and is well tolerated. Several series suggestthe median length of hospital stay (LOS) is 5 to 7 days andFrom the Divisions of Cardiac Critical Care Medicine and Cardiology, a DepartmentsofCriticalCareMedicineandPaediatrics,TheHospital forSickChildren, Toronto,Ontario, Canada;New England Research Institutes, b Watertown,Mass;Division ofPediatricCardiovascular Surgery, c Department ofCardiac Surgery,andDivision ofPediatric Cardiology, h Department of Pediatrics & Communicable Diseases, Uni-versity of Michigan Medical School, Ann Arbor, Mich; Division of Cardiology, dDepartment of Pediatrics, Duke University, Durham, NC; Division of PediatricCardiology, e Department of Pediatrics, Medical University of South Carolina,Charleston, SC; Division of Critical Care Medicine, f Department of Anesthesiaand Critical Care, Children’s Hospital of Philadelphia, Philadelphia, Pa; Divisionof Pediatric Cardiology, g Department of Pediatrics, Columbia University, NewYork, NY; Division of Cardiology, i Department of Pediatrics, Children’s HospitalLos Angeles, Los Angeles, Calif; Department of Cardiac Surgery j and Departmentof Cardiology, o Children’s Hospital Boston, Boston, Mass; Division of Cardiovas-cular Surgery, k Department of Surgery, Cincinnati Children’s Hospital MedicalCenter, Cincinnati, Ohio; Division of Pediatric Cardiothoracic Surgery, l Depart-mentofSurgery,AlfredI.duPontHospitalforChildren,Wilmington,Del;Divisionof Cardiovascular Surgery, m All Children’s Hospital, Tampa, Fla; Division of Pe-diatric Cardiology, n Department of Pediatrics, Primary Children’s Medical Center,Salt Lake City, Utah; Heart Development and Structural Diseases Branch, pDivision of Cardiovascular Sciences, National Heart, Lung, and Blood Institute,Bethesda,Md;DivisionofCardiothoracicSurgery, q DepartmentofSurgery,EmoryUniversity, Atlanta, Ga; and Division of Critical Care Medicine, r Department ofPediatrics, Children’s Hospital of Wisconsin, Milwaukee, Wis.This study was supported by U01 grants from the National Heart, Lung, and BloodInstitute (HL068269, HL068270, HL068279, HL068281, HL068285, HL068292,HL068290, HL068288, HL085057, HL109781, and HL109737). This work issolely the responsibility of the authors and does not necessarily represent theofficial views of the National Heart, Lung, and Blood Institute or the NationalInstitutes of Health.Disclosures: Authors have nothing to disclose with regard to commercial support.ClinicalTrials.gov number, NCT00115934.Received for publication April 2, 2013; revisions received July 5, 2013; accepted forpublication July 26, 2013; available ahead of print Sept 26, 2013.Address for reprints: Steven M. Schwartz, MD, Department of Critical CareMedicine, The Hospital for Sick Children and the University of Toronto, Toronto,ON, Canada (E-mail: steven.schwartz@sickkids.ca).0022-5223/$36.00Copyright ? 2014 by The American Association for Thoracic Surgeryhttp://dx.doi.org/10.1016/j.jtcvs.2013.07.063The Journal of Thoracic and Cardiovascular Surgeryc Volume 147, Number 61791CHDSchwartz et al Congenital Heart Disease
