Older children at the time of the Norwood operation have ongoing mortality vulnerability that continues after cavopulmonary connection Bahaaldin Alsoufi,

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Presentation transcript:

Older children at the time of the Norwood operation have ongoing mortality vulnerability that continues after cavopulmonary connection Bahaaldin Alsoufi, MD, Cedric Manlhiot, BSc, Mamdouh Al-Ahmadi, MD, Zohair Al-Halees, MD, Brian W. McCrindle, MD, Ahmed Yehia Mousa, MD, Yasser Al-Heraish, MD, Avedis Kalloghlian, MD The Journal of Thoracic and Cardiovascular Surgery Volume 142, Issue 1, Pages 142-147.e2 (July 2011) DOI: 10.1016/j.jtcvs.2011.01.064 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Competing risks depiction of events (death and transition to bidirectional cavopulmonary connection, with the remaining few patients alive and awaiting bidirectional cavopulmonary connection or transitioning directly to the Fontan operation) after Norwood-type first-stage palliation of HLHS and related pathologies in infants greater than 2 weeks of age. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 142-147.e2DOI: (10.1016/j.jtcvs.2011.01.064) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Competing risks depiction of events (death and transition to the Fontan operation) after bidirectional cavopulmonary connection (BCPC) in infants who underwent Norwood-type first-stage palliation at greater than 2 weeks of age. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 142-147.e2DOI: (10.1016/j.jtcvs.2011.01.064) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Time-dependent survival (A) and hazard risk of death (B) over time after Norwood-type first-stage palliation. The hazard function for death is characterized by the presence of an early hazard phase during the initial few months after surgical intervention. After that period, there is a constant attrition that continues up to 2 years after the initial operation. The solid lines in the parametric model represent parametric point estimates, and the dashed lines enclose the 95% confidence interval. Circles represent nonparametric estimates. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 142-147.e2DOI: (10.1016/j.jtcvs.2011.01.064) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Parametric model for survival after first-stage palliation stratified by weight group at the time of the initial operation. Lower weight was associated with higher mortality. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 142-147.e2DOI: (10.1016/j.jtcvs.2011.01.064) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Parametric model for survival after first-stage palliation stratified by dominant ventricular morphology. There was a trend for improved survival in patient with dominant left ventricular morphology compared with that seen in patients with dominant right ventricular morphology. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 142-147.e2DOI: (10.1016/j.jtcvs.2011.01.064) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Parametric model for survival after first-stage palliation stratified by the type of shunt at the time of first-stage palliation. There was a trend for improved survival in patients who had a modified Blalock–Taussig shunt compared with that seen in patients who had a right ventricle–pulmonary artery conduit (Sano shunt). The Journal of Thoracic and Cardiovascular Surgery 2011 142, 142-147.e2DOI: (10.1016/j.jtcvs.2011.01.064) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 Flow chart depicting events after first-stage Norwood-type palliation in 55 infants older than 2 weeks of age at the time of the operation. BCPC, Bidirectional cavopulmonary connection. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 142-147.e2DOI: (10.1016/j.jtcvs.2011.01.064) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions