Results of XXXX following failed staged palliation of @entity1699 and related @entity154

@entity1 @entity1699 @entity154 @entity299
OBJECTIVES: Multistage palliation is the mainstay management strategy of @entity1 with @entity1699 ( @entity1699 ) and related @entity154 . If this palliation strategy fails, @entity299 ( @entity299 ) is required. The results of @entity299 in @entity1 who had a prior Norwood operation are reportedly poor due to several immune, clinical and anatomical risk factors. We report our institutional outcomes following @entity299 in @entity1 who had a prior Norwood operation. METHODS: Between 1994 and 2013, 107 @entity1 with @entity299 underwent @entity299 . We examined early and late outcomes in our study cohort of @entity1 who had a prior Norwood operation (n = 24), and analysed risk factors affecting survival. Survival was subsequently compared with a control group of 83 @entity1 with @entity299 without a prior Norwood operation who received @entity299 . RESULTS: Twenty-four @entity1 with a prior Norwood operation underwent @entity299 . The majority (22/24, 92%) had @entity1699 . @entity1 were listed following Norwood (n = 2, 8.3%), Glenn (n = 17, 70.8%) or Fontan (n = 5, 20.8%) operation. Ten (42%) @entity1 had panel reactive antibodies (PRAs) >10%. Median age at listing was 2.7 (range 0.4-16.8) years and median age at the time of @entity299 was 3.0 (range 0.6-16.8) years, with the median waiting list duration of 63.5 (range 1-554) days. Hospital mortality was 1/24 (4%). Overall parametric survival estimates at 1, 5 and 10 years were 85, 65 and 52%. Survival was not affected by listing status, last palliation stage, age or high PRA. The only significant factor affecting survival was the later era in our series with significantly superior 5-year survival (100 vs 42%, P = 0.0003). Overall survival was comparable with the control group of @entity1 with @entity299 and no prior Norwood operation (52 vs 53% at 10 years, P = 0.97). Overall, 3 of 24 @entity1 required retransplantation with only one late survivor. CONCLUSIONS: @entity1 failing multistage palliation of @entity1699 may require @entity299 , often following the Glenn operation. @entity299 results in this group are comparable with those in other @entity1 with @entity299 . Improvements in pretransplant management, immune suppression and outpatient care in the later era might have specifically benefited this particularly risky group of @entity1 .
