@Article{chd.12849,
AUTHOR = {Christine M. Riley, Christopher W. Mastropietro, Peter Sassalos, Jason R. Buckley, John M. Costello, Ilias Iliopoulos, Aimee Jennings, Katherine Cashen, Sukumar Suguna Narasimhulu, Keshava M. N. Gowda, Arthur J. Smerling, Michael Wilhelm, Aditya Badheka, Adnan Bakar, Elizabeth A. S. Moser, Venu Amula},
TITLE = {Utilization of inhaled nitric oxide after surgical repair of truncus arteriosus: A multicenter analysis},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {6},
PAGES = {1078--1086},
URL = {http://www.techscience.com/schd/v14n6/38917},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> Elevated pulmonary vascular resistance (PVR) is common following
repair of truncus arteriosus. Inhaled nitric oxide (iNO) is an effective yet costly
therapy that is frequently implemented postoperatively to manage elevated PVR.<br/>
<b>Objectives:</b> We aimed to describe practice patterns of iNO use in a multicenter
cohort of patients who underwent repair of truncus arteriosus, a lesion in which
recovery is often complicated by elevated PVR. We also sought to identify patient
and center factors that were more commonly associated with the use of iNO in the 
postoperative period.<br/>
<b>Design:</b> Retrospective cohort study.<br/>
<b>Setting:</b> 15 tertiary care pediatric referral centers.<br/>
<b>Patients:</b> All infants who underwent definitive repair of truncus arteriosus without 
aortic arch obstruction between 2009 and 2016.<br/>
<b>Interventions:</b> Descriptive statistics were used to demonstrate practice patterns of 
iNO use. Bivariate comparisons of characteristics of patients who did and did not receive iNO were performed, followed by multivariable mixed logistic regression analysis using backward elimination to identify independent predictors of iNO use.<br/>
<b>Main Results:</b> We reviewed 216 patients who met inclusion criteria, of which 102 
(46%) received iNO in the postoperative period: 69 (68%) had iNO started in the operating room and 33 (32%) had iNO initiated in the ICU. Median duration of iNO use 
was 4 days (range: 1‐21 days). In multivariable mixed logistic regression analysis, use 
of deep hypothermic circulatory arrest (odds ratio: 3.2; 95% confidence interval: 1.2, 
8.4) and center (analyzed as a random effect, p = .02) were independently associated 
with iNO use.<br/>
<b>Conclusions:</b> In this contemporary multicenter study, nearly half of patients who underwent repair of truncus arteriosus received iNO postoperatively. Use of iNO was 
more dependent on individual center practice rather than patient characteristics. The 
study suggests a need for collaborative quality initiatives to determine optimal criteria for utilization of this important but expensive therapy.},
DOI = {10.1111/chd.12849}
}