by A recent study conducted by Reshma Reddy, M.D., a pediatric cardiac intensive care physician at the Medical University of South Carolina, has shown promising results in using digoxin to enhance post-surgery survival rates for infants born with single-ventricle physiology. Single-ventricle disorders, which occur in about 1% of babies born in the U.S. annually, result in only one functioning pumping chamber in the heart. This condition poses serious risks for infants and requires intervention to support heart function.
While there is currently no cure for single-ventricle disorders, researchers like Dr. Reddy are continuously seeking new approaches to improve outcomes for these patients. The recent study, published in the Journal of the American Heart Association, explored the use of digoxin as a treatment during a critical stage of single-ventricle patients’ care and found that it could enhance survival rates and lead to better outcomes.
Single-ventricle disorders, such as hypoplastic left heart syndrome, tricuspid atresia, and double-inlet left ventricle, occur due to developmental problems that result in a smaller, undeveloped lower heart chamber or a missing valve. Infants born with this condition have to rely on one functional pumping chamber, which requires the heart to work harder and less efficiently to deliver oxygenated blood to the body and retrieve deoxygenated blood from the lungs. Insufficient oxygen delivery can lead to various medical complications for these infants.
To support the heart function of infants with single-ventricle physiology, a series of surgeries is typically performed. The first surgery takes place at 7 to 14 days of age, followed by a second procedure when the infants are around 3 to 4 months old. The period between these surgeries, known as the interstage period, is when patients are at high risk and critically ill. However, the study conducted by Dr. Reddy and her team revealed that administering digoxin during the interstage period significantly lowered the risk for patients undergoing the hybrid procedure.
The hybrid procedure is an initial palliative surgery that serves as an alternative to the complex Norwood procedure. Unlike the Norwood procedure, which requires the use of a heart-and-lung bypass machine and poses significant risks, the hybrid procedure involves a combination of catheterization and surgery, without the need for bypass. This reduces stress on the already vulnerable patient population.
The study analyzed data collected from 259 infants who underwent the hybrid procedure at 45 different care centers between 2008 and 2021. Half of the infants received digoxin between their stage 1 and stage 2 surgeries, while the other half did not. The results showed that the infants treated with digoxin had significantly lower mortality rates and were less likely to require a transplant during the interstage period compared to those who did not receive the medication. This confirms previous findings related to the Norwood procedure and suggests that digoxin could benefit patients undergoing the hybrid procedure as well.
Considering the variation in care centers and their approaches to single-ventricle patients, it was essential to confirm the potential benefits of digoxin usage as long as patients tolerate the medication well. Currently, around 50% of care centers prescribe digoxin for this purpose, but the publication of this study may encourage other centers to adopt this practice and improve outcomes for this vulnerable patient population.
Dr. Reddy emphasized the need for innovative strategies to enhance the survival rates of these patients during their most vulnerable period of life. Any intervention that can increase the chances of survival for the sickest and most vulnerable infants can make a significant difference in their lives.
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1. Source: Coherent Market Insights, Public sources, Desk research
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