Abstract 15593: Impaired Maternal-Fetal Environment is Associated With Increased Mortality After Stage 1 Norwood Procedure for Single Ventricle Heart Disease

• Published in: Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A15593-A15593
• Main Authors: Savla, Jill J, Huang, Jing, Putt, Mary E, Moldenhauer, Julie S, Parry, Samuel, Reilly, Samantha, Youman, Olivia, Rychik, Jack, Mercer-Rosa, Laura, Gaynor, J W, Kawut, Steven M
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.15593

IntroductionThe maternal-fetal environment (MFE) may have a substantial impact on cardiac surgery outcomes. Single ventricle heart defects are managed with a staged approach and 5-year survival is 65% to 75%. We hypothesized that an impaired MFE would be associated with an increased risk of death after stage 1 Norwood procedure.MethodsWe performed a retrospective cohort study of subjects with single ventricle heart disease and aortic arch obstruction who were born between June 2008 and June 2018 and underwent stage 1 Norwood procedure at our center. Impaired MFE was defined as maternal gestational hypertension, preeclampsia, gestational diabetes, and/or cigarette smoking during pregnancy. The primary outcome was time until death. Multivariable Cox regression models were used to investigate the association between impaired MFE and mortality.ResultsOf the 273 neonatal subjects, 61% were male, 63% were White/Non-Hispanic, and 79% had hypoplastic left heart syndrome (HLHS). The median age at surgery was 4 days (IQR 3 - 6) the median follow-up time was 3.7 years (IQR 1.1 - 7.0). The 72 (26%) subjects exposed to an impaired MFE had more preterm births (18% vs. 7%) and lower birth weights. There were no significant differences between the groups in race/ethnicity, genetic syndrome, cardiac diagnosis, or birth era. Impaired MFE was associated with a significantly higher risk of death (HR 6.05, 95% CI 3.59 - 10.21, p < 0.001), after adjusting for age at surgery, ethnicity, cardiac diagnosis, genetic syndrome, birth era, and surgeon (Figure).ConclusionsSingle ventricle heart disease patients with impaired MFE have a higher risk of death following stage 1 Norwood procedure, after adjustment for potential confounders. Prenatal exposures are potentially modifiable factors that need to be taken into account when risk stratifying this vulnerable population.Figure. Adjusted Survival Curves for Impaired vs. Non-Impaired Maternal-Fetal Environment