Early Outcomes of Cardiac Surgery in Patients with Noonan Syndrome

Pouya Hemmati, Joseph A. Dearani, Richard C. Daly, Katherine S. King, Naser M. Ammash, Frank Cetta, Hartzell V Schaff

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

There is a paucity of cardiac surgery outcomes data for patients with Noonan syndrome (NS). Our objective was to evaluate early results in these patients. Between January 1999 and December 2015, 29 patients (18 males, 62%) with NS underwent cardiac surgery at our institution. Mean age was 23 ± 17.9 years; 12 (41%) were under 18 years of age. Fourteen patients (48%) had prior sternotomies. The primary operations for the main diagnosis were pulmonary valve/conduit replacement/repair (n = 14, 48%), septal myectomy for obstructive hypertrophic cardiomyopathy (n = 7, 24%), aortic valve replacement/repair (n = 4, 14%), atrial septal defect (ASD) repair (n = 2, 7%), and cardiac transplantation (n = 2, 7%). Concomitant procedures were performed in 24 patients (83%), most commonly right ventricular outflow tract reconstruction (n = 13, 45%), mitral valve repair/replacement (n = 7, 24%), and ASD repair (n = 6, 21%). Mean bypass and cross-clamp times were 88.8 ± 51 minutes and 54.7 ± 67 minutes, respectively. There was 1 early death (3%). Postoperative morbidity occurred in 18 patients (62%), most commonly arrhythmias (n = 14, 48%) or respiratory insufficiency/pneumonia (n = 6, 21%). There were 2 early reoperations and 4 early readmissions. Univariate factors associated with morbidity included male gender (P = 0.03) and longer cross-clamp time (P = 0.02). Median length of hospital stay was 6 days (interquartile range 5–10.5 days). Patients with NS frequently have multiple cardiac lesions requiring a broad spectrum of operations. Early mortality is low despite procedure complexity. Although early postoperative morbidity is common, patients overall do well with reasonable hospital lengths of stay. Additional studies are needed to evaluate long-term outcomes and quality of life.

Original languageEnglish (US)
JournalSeminars in Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Noonan Syndrome
Thoracic Surgery
Length of Stay
Morbidity
Pulmonary Valve
Sternotomy
Atrial Heart Septal Defects
Hypertrophic Cardiomyopathy
Heart Transplantation
Aortic Valve
Mitral Valve
Reoperation
Respiratory Insufficiency
Cardiac Arrhythmias
Pneumonia
Quality of Life
Mortality

Keywords

  • congenital heart disease
  • hypertrophic cardiomyopathy
  • Noonan Syndrome
  • pulmonary stenosis
  • septal myectomy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Early Outcomes of Cardiac Surgery in Patients with Noonan Syndrome. / Hemmati, Pouya; Dearani, Joseph A.; Daly, Richard C.; King, Katherine S.; Ammash, Naser M.; Cetta, Frank; Schaff, Hartzell V.

In: Seminars in Thoracic and Cardiovascular Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Hemmati, Pouya ; Dearani, Joseph A. ; Daly, Richard C. ; King, Katherine S. ; Ammash, Naser M. ; Cetta, Frank ; Schaff, Hartzell V. / Early Outcomes of Cardiac Surgery in Patients with Noonan Syndrome. In: Seminars in Thoracic and Cardiovascular Surgery. 2019.
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abstract = "There is a paucity of cardiac surgery outcomes data for patients with Noonan syndrome (NS). Our objective was to evaluate early results in these patients. Between January 1999 and December 2015, 29 patients (18 males, 62{\%}) with NS underwent cardiac surgery at our institution. Mean age was 23 ± 17.9 years; 12 (41{\%}) were under 18 years of age. Fourteen patients (48{\%}) had prior sternotomies. The primary operations for the main diagnosis were pulmonary valve/conduit replacement/repair (n = 14, 48{\%}), septal myectomy for obstructive hypertrophic cardiomyopathy (n = 7, 24{\%}), aortic valve replacement/repair (n = 4, 14{\%}), atrial septal defect (ASD) repair (n = 2, 7{\%}), and cardiac transplantation (n = 2, 7{\%}). Concomitant procedures were performed in 24 patients (83{\%}), most commonly right ventricular outflow tract reconstruction (n = 13, 45{\%}), mitral valve repair/replacement (n = 7, 24{\%}), and ASD repair (n = 6, 21{\%}). Mean bypass and cross-clamp times were 88.8 ± 51 minutes and 54.7 ± 67 minutes, respectively. There was 1 early death (3{\%}). Postoperative morbidity occurred in 18 patients (62{\%}), most commonly arrhythmias (n = 14, 48{\%}) or respiratory insufficiency/pneumonia (n = 6, 21{\%}). There were 2 early reoperations and 4 early readmissions. Univariate factors associated with morbidity included male gender (P = 0.03) and longer cross-clamp time (P = 0.02). Median length of hospital stay was 6 days (interquartile range 5–10.5 days). Patients with NS frequently have multiple cardiac lesions requiring a broad spectrum of operations. Early mortality is low despite procedure complexity. Although early postoperative morbidity is common, patients overall do well with reasonable hospital lengths of stay. Additional studies are needed to evaluate long-term outcomes and quality of life.",
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