The following is a summary of “Association of Digoxin Use With Transplant‐Free Interstage Survival in Infants Palliated With a Stage 1 Hybrid Procedure,” published in the October 2023 issue of Cardiology by Reddy et al.

In the context of single-ventricle physiology post-stage 1 palliation, the administration of digoxin has shown promise in reducing interstage mortality, particularly among patients who have undergone the Norwood procedure. However, the scope of previous studies has predominantly focused on patients treated with the Norwood procedure. Their investigation aimed to assess whether the prescription of digoxin at discharge for infants following hybrid stage 1 palliation correlated with enhanced transplant-free interstage survival.

Conducting a retrospective multicenter cohort analysis using data from the National Pediatric Cardiology Quality Improvement Collaborative registry between 2008 and 2021, the researchers identified infants with functional single ventricles and aortic arch obstruction discharged home after hospitalization for hybrid stage 1 palliation. Patients were excluded if they had supraventricular tachycardia or underwent conversion to the Norwood operation. The primary endpoint measured was transplant-free survival. Employing multivariable logistic regression analysis, which included a propensity score for digoxin use, the study group examined the association between digoxin administration and interstage mortality or need for transplant. Among the 259 infants from 45 sites included in the study, 158 (61%) had hypoplastic left heart syndrome. Notably, 49% had a gestational age of ≤38 weeks, 18% had a birth weight of <2.5 kg, and 58% presented with preoperative risk factors. Of these subjects, 129 (50%) were discharged with a prescription for digoxin. Interstage mortality or need for transplant was observed in 30 (23%) patients in the no-digoxin group compared to 18 (14%) in the digoxin group (P=0.06). Multivariate analysis revealed that discharge prescription of digoxin was linked to a reduced risk of interstage mortality or need for transplant (adjusted odds ratio, 0.48 [95% CI, 0.24–0.93]; P=0.03).

In summary, among infants with single-ventricle physiology who underwent hybrid stage 1 palliation, their findings suggest that the prescription of digoxin at discharge was associated with a notable improvement in transplant-free interstage survival.

Source: ahajournals.org/doi/10.1161/JAHA.123.029521