Faculty Collaboration Database

Norwood Procedure-Difficulty in Weaning From Cardiopulmonary Bypass and Implications for Outcomes. Semin Thorac Cardiovasc Surg 2020;32(1):119-125

Date

08/14/2019

Pubmed ID

31404609

Pubmed Central ID

PMC7007819

DOI

10.1053/j.semtcvs.2019.08.005

Scopus ID

2-s2.0-85071455853 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

Difficulty weaning from cardiopulmonary bypass (CPB) or the need to return to CPB (collectively D-CPB) may occur after the Norwood procedure. We sought to evaluate the relationship between D-CBP and survival. This was a retrospective chart review of all patients undergoing a Norwood procedure at our institution during the interval 2005-2017. Primary outcome was survival for the Norwood procedure. Secondary outcomes included various measures of morbidity. Successful wean from CBP (S-CPB) was defined as no need to return to full-flow CPB during the initial definitive wean or after separation from CPB; otherwise, the classification was difficulty with wean (D-CBP). Successful rescue in the D-CPB group was defined as not requiring extracorporeal life support either in the operating room or within the first 3 postoperative days. Of the 196 patients in the cohort, 49 were D-CPB. Survival for S-CPB was 92.5% (136/147) vs 71.4% (35/49) for D-CPB (P = 0.001). Major morbidity occurred in 29.9% (44/147) in S-CPB vs 69.4% (34/49) in D-CPB (P < 0.001). With multivariable analysis, D-CPB was significantly associated with mortality (odds ratio = 8.09; confidence interval 2.72-24.05; P < 0.001). Successful rescue occurred in 30 of 49 patients in the D-CPB group and demonstrated survival similar to the S-CPB group. In the Norwood patient, D-CPB is an important intraoperative event and prognostic factor for mortality and morbidity. Successful rescue appears to ameliorate the impact of D-CPB on survival.

Author List

Gellings JA, Johnson WK, Ghanayem NS, Mitchell M, Tweddell J, Hoffman G, Hraska V, Kuhn EM, Woods RK

Author

George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cardiopulmonary Bypass
Female
Heart Defects, Congenital
Humans
Infant, Newborn
Male
Norwood Procedures
Postoperative Complications
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome