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. 2011 Sep;19(9):369-72.
doi: 10.1007/s12471-011-0171-8.

Improving surgical outcome following the Norwood procedure

S O Algra  1 , J M P J Breur, F C M Evens, F de Roo, P H Schoof, F Haas
Affiliations

Improving surgical outcome following the Norwood procedure

S O Algra et al. Neth Heart J. 2011 Sep.

Abstract

Background: The Norwood procedure consists of three palliative operations, performed in neonates with hypoplastic left heart syndrome. Especially the first stage (Norwood I) is associated with the highest mortality rates in paediatric cardiac surgery (up to 25%). During surgery, the aorta is reconstructed and a systemic-to-pulmonary shunt is applied. Originally the modified Blalock-Taussig shunt was used, but recently the right-ventricle-to-pulmonary-artery shunt is increasingly being employed. We reviewed the results of our operative strategy, where an individualised choice of shunt is made. Furthermore, attempts to reduce interstage mortality (between Norwood I and II) were assessed.

Methods: All neonates who underwent Norwood stage I palliation from August 2004 until November 2010 were included in this retrospective analysis. Mortality rates and management strategies were compared.

Results: Thirty-six patients were available for analysis. Overall 30-day mortality was 5.6% (2 patients) and interstage mortality after discharge was 14% (5 patients). In 2006, a novel clinical protocol was introduced, aimed at reduction of mortality during the interstage period. This resulted in reduction of interstage mortality from 23% to 9% (3 of 13 infants, versus 2 of 23), with a cumulative survival of 82% (maximum follow-up 4 years).

Conclusion: Early surgical results following the Norwood procedure using an individualised shunt choice are favourable.

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Figures

Fig. 1
Fig. 1
The two variants of the Norwood I procedure; with modified BT shunt (top) and RV-PA shunt (bottom). Re-used with permission from Ohye et al. [8]
Fig. 2
Fig. 2
Kaplan-Meier survival curve
See this image and copyright information in PMC

References

    1. Hazekamp MG, Rijlaarsdam ME, Schoof PH, et al. Favourable results with surgical treatment in 43 children with hypoplastic left-heart syndrome or similar disorders, 1999–2005. Ned Tijdschr Geneeskd. 2006;150:1930–5. - PubMed
    1. Atallah J, Dinu IA, Joffe AR, et al. Two-year survival and mental and psychomotor outcomes after the Norwood procedure: an analysis of the modified Blalock-Taussig shunt and right ventricle-to-pulmonary artery shunt surgical eras. Circulation. 2008;118:1410–8. doi: 10.1161/CIRCULATIONAHA.107.741579. - DOI - PubMed
    1. European Association for Cardio-Thoracic Surgery: Mortality versus procedure, EACTS congenital database 2005. http://www.ctsnet.org/. Accessed 10 February 2011.
    1. Ghanayem NS, Hoffman GM, Mussatto KA, et al. Perioperative monitoring in high-risk infants after stage 1 palliation of univentricular congenital heart disease. J Thorac Cardiovasc Surg. 2010;140:857–63. doi: 10.1016/j.jtcvs.2010.05.002. - DOI - PubMed
    1. Graham EM, Zyblewski SC, Phillips JW, et al. Comparison of Norwood shunt types: do the outcomes differ 6 years later? Ann Thorac Surg. 2010;90:31–5. doi: 10.1016/j.athoracsur.2010.03.078. - DOI - PubMed