{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T06:25:15Z","timestamp":1791699915345,"version":"4.3.4"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,10,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The superior cavo\u2010pulmonary connection was introduced at our institution in 1988 for infants undergoing surgery for hypoplastic left heart syndrome. Patients with hypoplastic left heart syndrome remain at high risk for mortality in the time period between the Norwood procedure and the superior cavo\u2010pulmonary connection. The primary objectives of this study were to compare interstage mortality across 4 eras and analyze factors that may impact interstage mortality.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Patients with hypoplastic left heart syndrome who underwent the Norwood procedure, were discharged from the hospital, and were eligible for superior cavo\u2010pulmonary connection between January 1, 1988, and December 31, 2017, were included. The study period was divided into 4 eras based on changes in operative or medical management. Mortality rates were estimated with 95% CIs. Adjusted and unadjusted logistic regression models were used to identify risk factors for mortality. There were 1111 patients who met the inclusion criteria. Overall, interstage mortality was 120\/1111 (10.8%). Interstage mortality was significantly lower in era 4 relative to era 1 (4.6% versus 13.4%;\n              <jats:italic>P<\/jats:italic>\n              =0.02) during the time that age at the superior cavo\u2010pulmonary connection was the lowest (135\u00a0days;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01) and the interstage monitoring program was introduced. In addition, use of the right ventricle to pulmonary artery shunt was associated with decreased interstage mortality (\n              <jats:italic>P<\/jats:italic>\n              =0.02) and was more routinely practiced in era 4.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">During this 30\u2010year experience, the risk of interstage mortality decreased significantly in the most recent era. Factors that coincide with this finding include younger age at superior cavo\u2010pulmonary connection, introduction of an interstage monitoring program, and increased use of the right ventricle to pulmonary artery shunt.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.016889","type":"journal-article","created":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T09:11:28Z","timestamp":1600852288000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["Decreasing Interstage Mortality After the Norwood Procedure: A 30\u2010Year Experience"],"prefix":"10.1161","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8680-2626","authenticated-orcid":false,"given":"Michelle","family":"Kaplinski","sequence":"first","affiliation":[{"name":"Division of Pediatric Cardiology Department of Pediatrics Lucile Packard Children\u2019s Hospital Stanford University Palo Alto CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard F.","family":"Ittenbach","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Epidemiology Department of Pediatrics Cincinnati Children\u2019s Hospital University of Cincinnati College of Medicine Cincinnati OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0095-7094","authenticated-orcid":false,"given":"Mallory L.","family":"Hunt","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Department of Surgery The Children\u2019s Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Stephan","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Department of Surgery The Children\u2019s Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shobha S.","family":"Natarajan","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics The Children\u2019s Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chitra","family":"Ravishankar","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics The Children\u2019s Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Therese M.","family":"Giglia","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics The Children\u2019s Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Rychik","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics The Children\u2019s Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J.","family":"Rome","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics The Children\u2019s Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlene","family":"Mahle","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Department of Surgery The Children\u2019s Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea T.","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Department of Surgery The Children\u2019s Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Steven","sequence":"additional","affiliation":[{"name":"Division of Cardiac Anesthesia Department of Anesthesiology and Critical Care Medicine The Children\u2019s Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie M.","family":"Fuller","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Department of Surgery The Children\u2019s Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan C.","family":"Nicolson","sequence":"additional","affiliation":[{"name":"Division of Cardiac Anesthesia Department of Anesthesiology and Critical Care Medicine The Children\u2019s Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas L.","family":"Spray","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Department of Surgery The Children\u2019s Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. William","family":"Gaynor","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Department of Surgery The Children\u2019s Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher E.","family":"Mascio","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Department of Surgery The Children\u2019s Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(94)90562-2"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(05)81151-1"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.017682"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.05.019"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.05.020"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(00)02324-9"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.pcsu.2004.02.017"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2014.02.038"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.014107"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951118000926"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2007.12.012"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2005.04.046"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.PCC.0000201003.38320.63"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-004-0776-4"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-016-1465-9"},{"key":"e_1_3_1_17_2","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.118.010783","article-title":"Association of a home monitoring program with interstage and stage 2 outcomes","volume":"9","author":"Gardner MM","year":"2019","unstructured":"Gardner MM, Mercer\u2010Rosa L, Faerber J, DiLorenzo MP, Bates KE, Stagg A, Natarajan SS, Szwast A, Fuller S, Mascio CE, et al. Association of a home monitoring program with interstage and stage 2 outcomes. J Am Heart Assoc. 2019;9:e010783. DOI: 10.1161\/JAHA.118.010783.","journal-title":"J Am Heart Assoc"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.07.069"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2017.05.041"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-019-02172-6"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezr190"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2013.04.006"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-0803.2011.00509.x"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.115.001956"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2017.01.013"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(02)73575-7"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.04.028"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2006.05.103"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2010.03.045"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.120.016889","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:49:57Z","timestamp":1715600997000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.120.016889"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,6]]},"references-count":28,"journal-issue":{"issue":"19","published-print":{"date-parts":[[2020,10,6]]}},"alternative-id":["10.1161\/JAHA.120.016889"],"URL":"https:\/\/doi.org\/10.1161\/jaha.120.016889","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,6]]},"assertion":[{"value":"2020-04-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e016889"}}