Contemporary real-world outcomes of stage 1 palliation for single ventricle patients: A Kids' Inpatient Database Analysis

Eur J Cardiothorac Surg. 2025 Nov 20:ezaf423. doi: 10.1093/ejcts/ezaf423. Online ahead of print.

ABSTRACT

OBJECTIVES: Patients with a single ventricle and systemic outflow obstruction undergo one of three stage 1 palliative operations: Norwood-Sano, Norwood-Modified Blalock-Taussig-Thomas shunt (mBTTs), or stage 1 hybrid palliation. We evaluated real-world outcomes for patients undergoing stage 1 palliation strategies in a national dataset.

METHODS: The Kids' Inpatient Database (KID) was queried for patients undergoing Norwood and hybrid procedures for the years 2016, 2019, and 2019. Data were extracted using International Classification of Diseases (ICD-10) codes. Using survey weights, an estimated national cohort was derived. Multilevel, multivariable logistic regression models evaluated risk-adjusted mortality and post-operative extracorporeal membrane oxygenation (ECMO). Operations were plotted by hospital mortality for the entire sample.

RESULTS: A total of 1,918 patients underwent stage 1 palliation with Norwood-Sano (1046, 54.5%), Norwood-mBTT shunt (770, 40.1%), or hybrid procedure (102, 5.3%). Unadjusted inpatient mortality was 9.0% for Norwood-Sano, 11.5% for Norwood-mBTT shunt, and 18.7% for the hybrid procedure. After risk adjustment, there was no significant difference in risk-adjusted inpatient mortality for Norwood-mBTTs (OR 1.25, p = 0.248) or hybrid procedures (OR 2.01, p = 0.057) compared to Norwood-Sano. There was no difference in need for ECMO for Norwood-mBTT shunt (OR 0.90, p = 0.78), or hybrid procedure (OR 0.50, p = 0.37). Finally, compared to Norwood-Sano, the use of mBTTs or hybrid procedures was higher in high-mortality hospitals.

CONCLUSIONS: Compared to historical data, outcomes for stage 1 palliative procedures are improving over historical norms. There was no difference in risk-adjusted inpatient mortality or ECMO comparing Norwood-Sano to Norwood-mBTTs. These data may aid the evolution of operative strategies.

PMID:41264467 | DOI:10.1093/ejcts/ezaf423