Impact of Extracardiac Anomalies on Mortality and Morbidity in Staged Single Ventricle Palliation

Abstract

This study was intended to determine the impact of extracardiac anomalies on outcomes in patients with functional single ventricle who underwent staged palliation. We reviewed medical records of patients who underwent first-stage palliation at our center between 2001 and 2020. The prevalence and type of extracardiac anomalies were evaluated, and their impact on outcomes during staged palliation was analyzed. Among 602 patients who underwent first-stage palliation, 81 (14%) patients had associated with extracardiac anomalies. They were more frequently associated with prematurity (p=0.03) and low birth weight below 2.5 kg (p<0.01). Mortality between first-stage palliation and stage II was similar in patients with and without extracardiac anomalies (24.7 vs. 17.1%, p=0.10). However, mortality between stage II and stage III was significantly higher in patients with extracardiac anomalies compared to those without (22.2 vs. 12.5 %, p=0.02). Mortality after stage III was also higher in patients with extracardiac anomalies compared to those without (4.9 vs. 1.5%, p=0.04). In the sub-group analysis of 81 patients with extracardiac anomalies, renal anomalies were identified as a significant risk factor for mortality (p=0.03, HR: 2.44). The incidence of extracardiac anomalies in this study was 14 %, and patients with extracardiac anomalies were highly associated with prematurity and low birth weight. Presence of extracardiac anomalies was associated with higher mortality between stage II and stage III palliation and after stage III phase, but not before stage II. Among extracardiac anomalies, renal anomalies were identified as a risk factor for mortality.