Abstract 8621: Factors Associated with Superior Cavopulmonary Connection Timing and Outcomes in Infants with Single Ventricle: A Report from the Pediatric Heart Network's Infant Single Ventricle Trial

Abstract

Background: Factors that influence the timing of the superior cavopulmonary connection (SCPC) have not been well characterized. Studies identifying outcome predictors following the SCPC are contradictory. This analysis aims to identify factors associated with SCPC timing and surgical outcomes. Methods: The Pediatric Heart Network's Infant Single Ventricle trial database was used to identify participants who underwent SCPC. Age at SCPC, length of stay (LOS) and death by age 14 months were evaluated. Potential associated factors included patient demographics, measures from neonatal hospitalization and pre-SCPC visit, SCPC type, and the number of concurrent cardiac surgical procedures. Age at SCPC was analyzed by Cox proportional hazards regression. Natural log LOS was analyzed by multiple linear regression. Models were determined by stepwise selection methods adjusting for clinical site. Results: SCPC was performed in 193 subjects at a median age of 5.2 (IQR 4.2, 6.2) months and weight of 5.9 (IQR 5.3, 6.6) kg. Median LOS was 7 days (IQR 6, 10). There were 3 early deaths (during hospitalization) and 3 late deaths (between SCPC discharge and final 14 month study visit). Factors independently associated with age at SCPC and log LOS include: Other commonly cited factors including type of SCPC, valve regurgitation, ventricular ejection fraction and ventricular end-diastolic pressure were not independently associated with age at SCPC or log LOS. Conclusions: Significant variation among centers, independent of patient factors, highlights the controversy about optimal timing of SCPC. Earlier timing appears to be associated with case complexity and interim morbidities. Factors associated with LOS may offer insights for improving pre-SCPC care and surgical outcome. The risks and benefits of elective SCPC at younger age require further study.