In a groundbreaking development in pediatric cardiology, a recent study has unveiled the positive impact of digoxin prescription on the transplant-free interstage survival of infants with single-ventricle physiology following hybrid stage 1 palliation. The analysis found that for infants with single-ventricle physiology who underwent hybrid stage 1 palliation, the digoxin prescription at...
In a groundbreaking development in pediatric cardiology, a recent study has unveiled the positive impact of digoxin prescription on the transplant-free interstage survival of infants with single-ventricle physiology following hybrid stage 1 palliation. The analysis found that for infants with single-ventricle physiology who underwent hybrid stage 1 palliation, the digoxin prescription at hospital discharge is linked to improved transplant-free interstage survival.
The research, conducted using data from the National Pediatric Cardiology Quality Improvement Collaborative registry spanning over a decade, challenges conventional practices and offers a promising avenue for improving outcomes in a vulnerable population. The study results were published in the Journal of the American Heart Association.
The administration of digoxin to individuals with single-ventricle physiology post-stage 1 palliation has been linked to a decrease in interstage mortality. Previous research has predominantly focused on patients who underwent the Norwood procedure. Hence, researchers conducted a study to investigate whether prescribing digoxin upon discharge for infants following hybrid stage 1 palliation was correlated with enhanced transplant-free interstage survival.
Conducting a retrospective multicenter cohort analysis using data from the National Pediatric Cardiology Quality Improvement Collaborative registry spanning from 2008 to 2021, this study focused on infants with functional single ventricles and aortic arch obstruction discharged after hybrid stage 1 palliation. Exclusions were made for patients with supraventricular tachycardia or conversion to the Norwood operation. The primary outcome measured was transplant-free survival.
Findings:
Involving 259 infants from 45 sites, including 158 with hypoplastic left heart syndrome, the study observed that 50% of subjects were discharged on digoxin.
The incidence of interstage death or transplant was 23% in the no-digoxin group compared to 14% in the digoxin group (P=0.06).
Multivariate analysis, incorporating a propensity score for digoxin use, revealed that discharge digoxin prescription was associated with a lower risk of interstage death or transplant.
The study's conclusions signify a pivotal moment in pediatric cardiology, suggesting that digoxin prescription at hospital discharge could be a game-changer for infants undergoing hybrid stage 1 palliation. The positive association with improved transplant-free interstage survival emphasizes the need for a reevaluation of postoperative care strategies in this specific cohort.
Take home points: Through the analysis of data from a multicenter clinical registry, infants with single-ventricle heart defects who received digoxin prescriptions at the time of hospital discharge after undergoing stage 1 hybrid palliation exhibited elevated transplant-free survival during the interstage period. These results align with prior studies involving the stage 1 Norwood operation, indicating that the proactive use of digoxin may be a reasonable approach during the interstage period for infants who have undergone the stage 1 hybrid palliation procedure.
Further reading: Reddy RK, Zyblewski SC, Chowdhury SM, et al. Association of Digoxin Use With Transplant-Free Interstage Survival in Infants Palliated With a Stage 1 Hybrid Procedure. J Am Heart Assoc. 2023;12(20):e029521. doi:10.1161/JAHA.123.029521
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