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J Thorac Cardiovasc Surg 2000;119:720-731
© 2000 The American Association for Thoracic Surgery

SURGERY FOR CONGENITAL HEART DISEASE

HYPOPLASTIC LEFT HEART SYNDROME: VALUING THE SURVIVAL

From the International Center for Health Outcomes and Innovation Research, Departments of Surgery, Medicine, Pediatrics, and School of Public Health, Columbia University, College of Physicians and Surgeons, New York Presbyterian Hospital, and Babies and Children’s Hospital, New York, NY.

Address for reprints: Annetine C. Gelijns, PhD, International Center for Health Outcomes and Innovation Research, Columbia University, 180 Fort Washington Ave, Harkness Pavillion Room 758, New York, NY 10032 (E-mail: acp10{at}columbia.edu ).

Objective: To examine the survival, developmental status, quality of life, and direct medical costs of children with hypoplastic left heart syndrome who have undergone stage I, II, and III reconstructive surgery.
Methods: A total of 106 children underwent staged repair for classic hypoplastic left heart syndrome between February 1990 and March 1999 (stage I: 106; stage II: 49; stage III: 25; 4 converted to heart transplantation). Survival was analyzed by the Kaplan-Meier method. In a cross-sectional study, parents assessed quality of life by completing the Infant/Toddler Child Health Questionnaire or Child Health Questionnaire Parent Format-28; they assessed developmental progress by completing the Ages and Stages Questionnaire. The ratio-of-costs-to-charges method was used to derive hospital costs, and payments were used to capture physician time and wholesale pricing for outpatient medications.
Results: Institutional 1-year and 5-year actuarial survivals were 58% and 54%. Birth weight, the need for preoperative inotropic drugs, and surgical experience were predictors of survival. Norwood I patients achieved fewer developmental benchmarks than those who survived to subsequent stages. Child Health Questionnaire Parent Format-28 mean summary scores for physical and psychosocial health were 48.5 ± 6.3 and 42.8 ± 9.9. The median inpatient costs for stage I, II, and III repairs were $51,000, $33,892, and $52,183, respectively. Monthly outpatient and readmission costs were less than 10% of total costs.
Conclusion: A prospective, large-scale study of the comprehensive outcomes of staged repair and transplantation is needed. This study will need to address the longer-term developmental and quality-of-life outcomes, as well as the long-term cost effectiveness of these procedures.

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