Development of Weight and Height Age z-Score after Total Cavopulmonary Connection

Abstract

Objective We aimed to analyze somatic growth of patients after total cavopulmonary connection (TCPC) as well as to identify factors influencing postoperative catch-up growth.

Methods A total of 309 patients undergoing TCPC at 4 years old or less between 1994 and 2021 were included. Weight for age z-score (WAZ) and height for age-z-score (HAZ) at TCPC and at postoperative time between 1 and 3 years were calculated. Factors influencing somatic growth were analyzed.

Results Most frequent diagnosis and initial palliation were hypoplastic left heart syndrome (HLHS) (34%) and the Norwood procedure (51%), respectively. Median age and weight at TCPC were 2.0 (IQR: 1.7–2.5) years and 11.3 (10.5–12.7) kg, respectively. Median 519 days after TCPC, a significant increase in WAZ (−0.4 to −0.2, p < 0.001) was observed, but not in HAZ (−0.6 to −0.6, p = 0.38). Older age at TCPC (p < 0.001, odds ratio [OR]: 2.6) and HLHS (p = 0.007, OR: 2.2) were risks for low WAZ after TCPC. Older age at TCPC (p = 0.009, OR: 1.9) and previous Norwood procedure (p = 0.021, OR: 2.0) were risks for low HAZ after TCPC. Previous bidirectional cavopulmonary shunt (BCPS) was a protective factor for both WAZ (p = 0.012, OR: 0.06) and HAZ (p = 0.028, OR: 0.30) at TCPC.

Conclusion In patients undergoing TCPC at the age of 4 years or less, a significant catch-up growth was observed in WAZ after TCPC, but not in HAZ. Previous BCPS resulted to be a protective factor for a better somatic development at TCPC. HLHSs undergoing Norwood were considered as risks for somatic development after TCPC.

Keywords

somatic development - weight for age z-score - single ventricle - total cavopulmonary connection - ventricular

Note

Presented at the 52nd Annual Meeting of the German Society of Thoracic and Cardiovascular Surgery, Hamburg, Germany, February 11–14, 2023.

Authors' Contribution

C.B.: conception and design of the work, data collection, analysis and interpretation of the data, drafting the manuscript. H.S.: data collection, drafting the manuscript. C.N.: data collection. T.S.: analysis and interpretation of the data, statistical analysis. M.C.: conception and design of the work. P.P.H.: analysis and interpretation of the data. M.B.: statistical analysis. N.P.: analysis and interpretation of the data. A.H.: critical revision of the manuscript. P.E.: conception and design of the work, critical revision of the manuscript. J.H.: conception and design of the work, critical revision of the manuscript. M.O.: conception and design of the work, drafting the manuscript.

^* These authors contributed equally.

Publication History

Received: 13 May 2023

Accepted: 17 August 2023

Accepted Manuscript online:
22 August 2023

Article published online:
16 October 2023

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