The following is the summary of “Cumulative comorbid conditions influence mortality risk after staged palliation for hypoplastic left heart syndrome and variants” published in the January 2023 issue of Thoracic and cardiovascular surgery by Backes, et al.

High-risk circumstances associated with death following stage 1 palliation include prematurity, low birth weight, genetic disorders, extracardiac diseases, and secondary cardiac abnormalities. Researchers discuss how these factors affected the results of a planned multi-center improvement collaboration. Patients’ information was requested from the National Pediatric Cardiology Quality Improvement Collaborative Phase II registry. The impact of several high-risk diagnoses on making it to 1 year of age was calculated by classifying and quantifying comorbid diseases. Mortality risk factors were analyzed using logistic regression.

About 575 (40%) of the total 1,421 participants had several risk factors. Overall, the high-risk cohort fared worse than the control group regarding survival to the first birthday (76.2% vs. 88.1%, P<.001). Survival to the first birthday was not significantly decreased in the presence of a single high-risk diagnosis (odds ratio, 0.71; confidence range, 0.49-1.02, P=.066). Having more than two high-risk diagnoses was related to a lower chance of making it to the first birthday (odds ratio, 0.23; CI, 0.15-0.36, P<.001), and having three or more increased that risk to 0.17 (CI, 0.10-0.30, P<.001). Multiple high-risk diagnoses, post-stage 1 palliation extracorporeal membrane oxygenation support (odds ratio, 0.14; CI, 0.10-0.22, P<.001), and cardiac reoperation (odds ratio, 0.66; CI, 0.45-0.98, P=.037) were associated with decreased survival odds to the first birthday in an additional analysis that included Prestage 1 palliation characteristics and stage 1 palliation perioperative variables

As many as 1 high-risk diagnostic categories could be present without causing a significant drop in survival after a year. The likelihood of survival was lower for people who had been diagnosed with more than one condition in the high-risk groups. More patients must be enrolled so that the effects of individual comorbidities within the larger high-risk categories can be assessed.

Source: sciencedirect.com/science/article/abs/pii/S0022522322003646