1. Supplement, Optimal Timing of Stage 2
CHSS Fall Work Weekend
Jim Meza

2. % Months since Norwood Poor candidate for Stage 2 7 months 4.8 months
 Risk Factor for Death
Value
After Norwood
Birth weight (kg)
2.5 kg
MBTS vs. RVPA conduit
MBTS
Smaller TV diameter (cm) on baseline echo, indexed to BSA
6.92
Aortic valve atresia on baseline echo No
After S2P
RV dysfunction on pre-S2P echo, moderate or severe
Yes
Younger age at S2P (days), natural log transformation
N/A
Weight-for-age z-score on pre-S2P cardiac catheterization
-2.1
Required MCS post-Norwood
7 months
4.8 months %
3.5 months
2 months
Months since Norwood

3. % Months since Norwood Poor candidate for Stage 2
Blue, purple = RVPA conduit
Green, orange = MBTS
 Risk Factor for Death
Value
After Norwood
Birth weight (kg)
2.5 kg
MBTS vs. RVPA conduit
Smaller TV diameter (cm) on baseline echo, indexed to BSA
6.92
Aortic valve atresia on baseline echo No
After S2P
RV dysfunction on pre-S2P echo, moderate or severe
Yes
Younger age at S2P (days), natural log transformation
Weight-for-age z-score on pre-S2P cardiac catheterization
-2.1
Required MCS post-Norwood
RVPA
MBTS
7 months
4.8 months
7 months %
4.8 months
3.5 months
3.5 months
I would interpret that as – if you are a poor candidate for stage 2 and require intervention at an early age – shunt type does not matter and the survival cost will be very high
2 months
2 months
Months since Norwood

4. % Months since Norwood Patient with more RF for death after Norwood
 Risk Factor for Death
Value
After Norwood
Birth weight (kg)
2.8 kg
MBTS vs. RVPA conduit
MBTS
Smaller TV diameter (cm) on baseline echo, indexed to BSA
6.08
Aortic valve atresia on baseline echo
Yes
After S2P
RV dysfunction on pre-S2P echo, moderate or severe No
Younger age at S2P (days), natural log transformation
N/A
Weight-for-age z-score on pre-S2P cardiac catheterization
-1.8
Required MCS post-Norwood
2.5 months
2 months %
5.3 months
7 months
This figure was for our patient with characteristics that place them at higher risk for death after the Norwood operation (MTS, lower birthweight, +AA). S2P appears it may rescue these patients. Compare with previous slide, who is a poor candidate for CPS, with RV dysfunction and a lower weight for age z-score, who takes a bigger hit for mortality based on younger age at stage 2, and who appars to have a much greater risk for perioperative mortality, especially when younger at tiem of stage 2.
Months since Norwood

5. % Months since Norwood Patient with more RF for death after Norwood
Blue, purple = RVPA conduit
Green, orange = MBTS
 Risk Factor for Death
Value
After Norwood
Birth weight (kg)
2.8 kg
MBTS vs. RVPA conduit
Smaller TV diameter (cm) on baseline echo, indexed to BSA
6.08
Aortic valve atresia on baseline echo
Yes
After S2P
RV dysfunction on pre-S2P echo, moderate or severe No
Younger age at S2P (days), natural log transformation
N/A
Weight-for-age z-score on pre-S2P cardiac catheterization
-1.8
Required MCS post-Norwood
RVPA
5.3 months
2.5 months
MBTS
7 months
2.5 months %
5.3 months
7 months
Months since Norwood