Mixed Venous Oxygen Saturation Monitoring After Stage 1 Palliation for Hypoplastic Left Heart Syndrome James S. Tweddell, MD, Nancy S. Ghanayem, MD,

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Mixed Venous Oxygen Saturation Monitoring After Stage 1 Palliation for Hypoplastic Left Heart Syndrome James S. Tweddell, MD, Nancy S. Ghanayem, MD, Kathleen A. Mussatto, BSN, Michael E. Mitchell, MD, Luke J. Lamers, MD, Ndidiamaka L. Musa, MD, Stuart Berger, MD, S. Bert Litwin, MD, George M. Hoffman, MD The Annals of Thoracic Surgery Volume 84, Issue 4, Pages 1301-1311 (October 2007) DOI: 10.1016/j.athoracsur.2007.05.047 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The outcome of 116 patients with hypoplastic left heart syndrome (HLHS) undergoing a Norwood procedure using a systemic–to–pulmonary artery shunt. (BDG = bidirectional Glenn; BT = Blalock-Taussig.) The Annals of Thoracic Surgery 2007 84, 1301-1311DOI: (10.1016/j.athoracsur.2007.05.047) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Kaplan-Meier survival for all 116 patients undergoing stage 1 palliation of hypoplastic left heart syndrome with a systemic–to–pulmonary artery shunt. The Annals of Thoracic Surgery 2007 84, 1301-1311DOI: (10.1016/j.athoracsur.2007.05.047) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The hourly superior vena cava oxygen saturation (Svo2) for all 116 patients is shown with the standard deviation (error bars), separated by the outcome endpoints of uncomplicated survival, survival with complications, and early mortality. The Svo2 was higher in uncomplicated survivors compared with survivors with complications, and in turn, survivors with complications had higher Svo2 than patients who sustained early mortality (p = 0.03). In addition survivors, showed a gradual increase in Svo2, whereas patients in the early mortality group had a decrease in SvO2 in the first 6 hours after return to the intensive care unit. The Annals of Thoracic Surgery 2007 84, 1301-1311DOI: (10.1016/j.athoracsur.2007.05.047) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Among patients in the lowest 25th percentile for superior vena cava oxygen saturation (Svo2) upon arrival to the cardiac intensive care unit, a failure of the Svo2 to normalize in the first 18 hours was characteristic of those in the early mortality group (black circles). These data suggest that efforts to increase a low SvO2 are successful in a proportion of patients with the lowest Svo2. (Error bars show the standard deviation. Clear circles = uncomplicated survival; patterned circles = survival with complications.) The Annals of Thoracic Surgery 2007 84, 1301-1311DOI: (10.1016/j.athoracsur.2007.05.047) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Risk of complications according to postoperative superior vena cava oxygen saturation (Svo2) assessed hourly for 48 hours. The * indicates a significant difference from risk at lower Svo2 in time-series regression. (Error bars show the standard deviation. Blue line = any complication; black line = any mortality; gray line = cardiopulmonary resuscitation [CPR]; orange line = extracorporeal membrane oxygenation [ECMO]; green line = early death; red line = early ECMO.) The Annals of Thoracic Surgery 2007 84, 1301-1311DOI: (10.1016/j.athoracsur.2007.05.047) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions