Clinical and haemodynamic variables associated with intensive care unit length of stay and early adverse outcomes after the Norwood procedure

Helena Staehler, Masamichi Ono, Patrick Schober, Takashi Kido, Paul Philipp Heinisch, Martina Strbad, Janez Vodiskar, Julie Cleuziou, Julia Lemmer, Gunter Balling, Alfred Hager, Peter Ewert, Jürgen Hörer

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

OBJECTIVES: This study was performed to determine the clinical and haemodynamic variables associated with early adverse outcomes after the neonatal Norwood procedure. METHODS: Patients who underwent the neonatal Norwood procedure between 2001 and 2019 were included. The patient diagnosis, morphological characteristics and haemodynamic parameters were analysed to identify factors associated with length of stay (LOS) in the intensive care unit (ICU) and mortality during the stay. RESULTS: A total of 322 patients were depicted. The median age and weight at the Norwood procedure were 9 days and 3.2 kg, respectively. Certain morphological and preoperative parameters, such as birth weight below 2.5 kg, restrictive atrial septal defect, extracardiac anomalies and the diameter of the ascending aorta, were found to be associated with the LOS in the ICU. Analysis using early postoperative haemodynamic variables revealed that systolic arterial pressure, diastolic arterial pressure, serum lactate levels and reduced ventricular function at 2 days postoperatively were associated with the LOS in the ICU. Birth weight <2.5 kg (P = 0.010), a restrictive atrial septal defect (P = 0.001) and smaller ascending aorta (P = 0.039) were associated with death in the ICU. Reduced ventricular function, lower systolic aortic pressure and higher lactate levels at various time points (P < 0.05) were also associated with ICU deaths. The LOS in the ICU was significantly associated with late mortality (P < 0.001, Hazard Ratio (HR) = 1.015). CONCLUSIONS: The LOS in the ICU after the Norwood procedure was predicted by early postoperative haemodynamic variables, suggesting that good early postoperative haemodynamics determine early recovery. A prolonged stay in the ICU after the Norwood procedure was associated with late mortality.

Original languageEnglish
Pages (from-to)1271-1280
Number of pages10
JournalEuropean Journal of Cardio-thoracic Surgery
Volume61
Issue number6
DOIs
StatePublished - 1 Jun 2022

Keywords

  • Adverse events
  • Hypoplastic left heart syndrome
  • Intensive care unit
  • Length of stay
  • Mortality

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