Impact of home monitoring program on inter-stage mortality after the Norwood procedure

Abstract

Background While early outcome after the Norwood operation for hypoplastic left heart syndrome has improved, inter-stage mortality until bidirectional cavopulmonary shunt (BCPS) remains a concern. Our aim was to institute a home monitoring program to (HMP) reduce inter-stage mortality. Methods Among 264 patients who survived Norwood procedure and were discharged before BCPS, 80 patients were included in the HMP and compared to the remaining 184 patients regarding inter-stage mortality. In patients with HMP, events during the inter-stage period were evaluated. Results Inter-stage mortality was 8% (n = 21) and was significantly lower in patients with HMP (2.5%, n = 2), compared to those without (10.3%, n = 19, p = 0.031). Patients with inter-stage mortality had significantly lower birth weight (p < 0.001) compared to those without. Lower birth weight (p < 0.001), extracorporeal membrane oxygenation support (p = 0.002), and lack of HMP (p = 0.048) were risk factors for inter-stage mortality. Most frequent event during home monitoring was low saturation (< 70%) in 14 patients (18%), followed by infection in 6 (7.5%), stagnant weight gain in 5 (6.3%), hypoxic shock in 3 (3.8%) and arrhythmia in 2 (2.5%). Unexpected readmission was needed in 24 patients (30%). In those patients, age (p = 0.001) and weight at BCPS (p = 0.007) were significantly lower compared to those without readmission, but the survival after BCPS was comparable between the groups. Conclusions Inter-stage HMP permits timely intervention and led to an important decrease in inter-stage mortality. One-third of the patients with home monitoring program needed readmission and demonstrated the need for earlier stage 2 palliation.