10-YEAR INSTITUTIONAL EXPERIENCE WITH PALLIATIVE SURGERY FOR HYPOPLASTIC LEFT-HEART SYNDROME - RISK-FACTORS RELATED TO STAGE-I MORTALITY

Background We reviewed 212 consecutive patients who underwent stage I palliative surgery for hypoplastic left heart syndrome (HLHS) at our i nstitution between January 1983 and June 1993. Methods and Results Six surgeons participated in the care of these patients. Follow-up is 97% complete. Preoperative anatomic and physiological factors and procedu ral features of the stage I operation were analyzed for impact on stag e I mortality, survival to stage II palliation, and actuarial survival . Hospital mortality was not significantly lower during the second hal f of the study period (P=.242). Operative mortality was 46.2%. Multiva riate analysis revealed improved stage I operative survival in patient s with mitral stenosis (MS) and aortic stenosis (AS; P=.006). Addition al risk factors for stage I mortality were a lower immediately pre-sta ge I pH (P=.034) and weight <3 kg (P=.015). Overall first-year actuari al survival for MS/AS was 59%, and it was 33% for all others (P=.001). Among stage I survivors, patients with MS/AS were more likely to surv ive to stage II palliation (P=.031). Analysis of actuarial survival of stage I survivors showed that a smaller ascending aorta (P<.001), aor tic atresia (P<.001), and mitral atresia (P=.002) were all risk factor s for intermediate death. Conclusions Preoperative anatomic and physio logical state are predictors of stage I mortality. HLHS anatomic subty pe also influences intermediate outcome, most notably pre-stage II att rition. These data may be useful in choosing initial management for pa tients with HLHS.