Factors associated with mortality and the need for re-intervention after stage 1 palliation for single ventricle heart disease

Background: Single ventricle management comprises a series of complex surgical procedures that are initiated during the newborn period. Despite advancements in surgical techniques, infants with a single ventricle face high mortality and the likelihood of unplanned reinterventions. Understanding the factors contributing to these reinterventions potentially could enhance patient outcomes, improve preoperative risk counseling to the families, and optimize resource utilization.

Methods: We analyzed data from the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry, focusing on infants who underwent Stage 1 single ventricle palliation between 2016 and 2019. Demographic and clinical characteristics, along with perioperative events, were examined in relation to the incidence of an unplanned reintervention (defined as all cardiac surgery or catheterization) and mortality prior to the implementation of Stage 2 palliation.

Results: Of 1823 patients analyzed, 419 (23%) experienced unplanned reinterventions, and 170 (9%) died before a Stage 2 procedure could take place. Risk factors for the combined outcome of mortality or reintervention included prematurity (RR 1.58 95%CI:1.32-1.89), restrictive atrial septum (RR 1.41 95%CI:1.19-1.68), and significant atrioventricular valve regurgitation (RR 1.92 95%CI: 1.47-2.49).

Conclusions: The findings of this study highlight several factors associated with unplanned reinterventions and mortality in infants undergoing Stage 1 single ventricle palliation. These observations can inform preoperative risk counseling for families and guide clinical decision-making to a modest extent. However, further research is needed to identify stronger predictors of long-term outcomes in this high-risk population.