Variation in Preoperative and Intraoperative Care for First-stage Palliation of Single-ventricle Heart Disease: A Report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative

David W. Brown, Jean A. Connor, Frank A. Pigula, Kudret Usmani, Thomas S. Klitzner, Robert H. Beekman, John Dale Kugler, Gerard R. Martin, Steven R. Neish, Geoffrey L. Rosenthal, Carole Lannon, Kathy J. Jenkins

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background and Methods. As the first multicenter quality improvement collaborative in pediatric cardiology, the Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement Collaborative registry collects information on the clinical care and outcomes of infants discharged home after first-stage palliation of single-ventricle heart disease, the Norwood operation, and variants. We sought to describe the preoperative and intraoperative characteristics of the first 100 patients enrolled in the National Pediatric Cardiology Quality Improvement Collaborative registry. Results. From 21 contributing centers, 59% of infants were male, with median birth weight of 3.1kg (1.9-5.0kg); the majority had hypoplastic left heart syndrome (71%). A prenatal diagnosis of congenital heart disease was made in 75%; only one had fetal cardiac intervention. Chromosomal anomalies were present in 8%, and major noncardiac organ system anomalies were present in 9%. Preoperative risk factors were common (55%) but less frequent in those with prenatal cardiac diagnosis (P=.001). Four patients underwent a preoperative transcatheter intervention. Substantial variation across participating sites was demonstrated for choice of initial palliation for the 93 patients requiring a full first-stage approach, with 50% of sites performing stage I with right ventricle to pulmonary artery conduit as the preferred operation; 89% of hybrid procedures were performed at a single center. Significant intraoperative variation by site was noted for the 83 patients who underwent traditional surgical stage I palliation, particularly with use of regional perfusion and depth of hypothermia. Conclusions. In summary, there is substantial variation across surgical centers in the successful initial palliation of infants with single-ventricle heart disease, particularly with regard to choice of palliation strategy, and intraoperative techniques including use of regional perfusion and depth of hypothermia. Further exploration of the relationship of such variables to subsequent outcomes after hospital discharge may help reduce variability and improve long-term outcomes.

Original languageEnglish (US)
Pages (from-to)108-115
Number of pages8
JournalCongenital Heart Disease
Volume6
Issue number2
DOIs
StatePublished - Mar 1 2011

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Intraoperative Care
Preoperative Care
Quality Improvement
Heart Diseases
Joints
Cardiology
Pediatrics
Hypothermia
Prenatal Diagnosis
Registries
Perfusion
Norwood Procedures
Hypoplastic Left Heart Syndrome
Infant Care
Birth Weight
Pulmonary Artery
Heart Ventricles

Keywords

  • Cardiac
  • Congenital Heart Disease
  • Pediatric
  • Quality Improvement

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Variation in Preoperative and Intraoperative Care for First-stage Palliation of Single-ventricle Heart Disease : A Report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. / Brown, David W.; Connor, Jean A.; Pigula, Frank A.; Usmani, Kudret; Klitzner, Thomas S.; Beekman, Robert H.; Kugler, John Dale; Martin, Gerard R.; Neish, Steven R.; Rosenthal, Geoffrey L.; Lannon, Carole; Jenkins, Kathy J.

In: Congenital Heart Disease, Vol. 6, No. 2, 01.03.2011, p. 108-115.

Research output: Contribution to journalArticle

Brown, David W. ; Connor, Jean A. ; Pigula, Frank A. ; Usmani, Kudret ; Klitzner, Thomas S. ; Beekman, Robert H. ; Kugler, John Dale ; Martin, Gerard R. ; Neish, Steven R. ; Rosenthal, Geoffrey L. ; Lannon, Carole ; Jenkins, Kathy J. / Variation in Preoperative and Intraoperative Care for First-stage Palliation of Single-ventricle Heart Disease : A Report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. In: Congenital Heart Disease. 2011 ; Vol. 6, No. 2. pp. 108-115.
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abstract = "Background and Methods. As the first multicenter quality improvement collaborative in pediatric cardiology, the Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement Collaborative registry collects information on the clinical care and outcomes of infants discharged home after first-stage palliation of single-ventricle heart disease, the Norwood operation, and variants. We sought to describe the preoperative and intraoperative characteristics of the first 100 patients enrolled in the National Pediatric Cardiology Quality Improvement Collaborative registry. Results. From 21 contributing centers, 59{\%} of infants were male, with median birth weight of 3.1kg (1.9-5.0kg); the majority had hypoplastic left heart syndrome (71{\%}). A prenatal diagnosis of congenital heart disease was made in 75{\%}; only one had fetal cardiac intervention. Chromosomal anomalies were present in 8{\%}, and major noncardiac organ system anomalies were present in 9{\%}. Preoperative risk factors were common (55{\%}) but less frequent in those with prenatal cardiac diagnosis (P=.001). Four patients underwent a preoperative transcatheter intervention. Substantial variation across participating sites was demonstrated for choice of initial palliation for the 93 patients requiring a full first-stage approach, with 50{\%} of sites performing stage I with right ventricle to pulmonary artery conduit as the preferred operation; 89{\%} of hybrid procedures were performed at a single center. Significant intraoperative variation by site was noted for the 83 patients who underwent traditional surgical stage I palliation, particularly with use of regional perfusion and depth of hypothermia. Conclusions. In summary, there is substantial variation across surgical centers in the successful initial palliation of infants with single-ventricle heart disease, particularly with regard to choice of palliation strategy, and intraoperative techniques including use of regional perfusion and depth of hypothermia. Further exploration of the relationship of such variables to subsequent outcomes after hospital discharge may help reduce variability and improve long-term outcomes.",
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AU - Pigula, Frank A.

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