passages: 2359
passages: document
passages: Intermediate-term mortality and cardiac transplantation in infants with single-ventricle lesions : risk factors and their interaction with shunt type . OBJECTIVE The study objective was to identify factors associated with death and cardiac transplantation in infants undergoing the Norwood procedure and to determine differences in associations that might favor the modified Blalock-Taussig shunt or a right ventricle-to-pulmonary artery shunt . METHODS We used competing risks methodology to analyze death without transplantation , cardiac transplantation , and survival without transplantation . Parametric time-to-event modeling and bootstrapping were used to identify independent predictors . RESULTS Data from 549 subjects ( follow-up , 2.7 ± 0.9 years ) were analyzed . Mortality risk was characterized by early and constant phases ; transplant was characterized by only a constant phase . Early phase factors associated with death included lower socioeconomic status ( P = .01 ) , obstructed pulmonary venous return ( P < .001 ) , smaller ascending aorta ( P = .02 ) , and anatomic subtype . Constant phase factors associated with death included genetic syndrome ( P < .001 ) and lower gestational age ( P < .001 ) . The right ventricle-to-pulmonary artery shunt demonstrated better survival in the 51 % of subjects who were full term with aortic atresia ( P < .001 ) . The modified Blalock-Taussig shunt was better among the 4 % of subjects who were preterm with a patent aortic valve ( P = .003 ) . Lower pre-Norwood right ventricular fractional area change , pre-Norwood surgery , and anatomy other than hypoplastic left heart syndrome were independently associated with transplantation ( all P < .03 ) , but shunt type was not ( P = .43 ) . CONCLUSIONS Independent risk factors for intermediate-term mortality include lower socioeconomic status , anatomy , genetic syndrome , and lower gestational age . Term infants with aortic atresia benefited from a right ventricle-to-pulmonary artery shunt , and preterm infants with a patent aortic valve benefited from a modified Blalock-Taussig shunt . Right ventricular function and anatomy , but not shunt type , were associated with transplantation .
entities: 2360
entities: Intervention_Surgical
entities: cardiac transplantation
entities: 2361
entities: Intervention_Surgical
entities: cardiac transplantation
entities: 2362
entities: Outcome_Mortality
entities: Mortality risk
entities: 2363
entities: Outcome_Physical
entities: with death
entities: 2364
entities: Outcome_Physical
entities: with death
entities: 2365
entities: Outcome_Mortality
entities: survival
entities: 2366
entities: Participant_Age
entities: infants
entities: 2367
entities: Participant_Condition
entities: single-ventricle lesions
entities: 2368
entities: Participant_Age
entities: infants
entities: 2369
entities: Participant_Condition
entities: undergoing the Norwood procedure
entities: 2370
entities: Participant_Sample-size
entities: 549