Faculty Collaboration Database

Survival After Norwood Procedure in High-Risk Patients. Ann Thorac Surg 2020 Mar;109(3):828-833

Date

09/15/2019

Pubmed ID

31520639

DOI

10.1016/j.athoracsur.2019.07.070

Scopus ID

2-s2.0-85077330663 (requires institutional sign-in at Scopus site)   27 Citations

Abstract

BACKGROUND: Multiple single-ventricle populations are noted to be at increased risk for mortality after the Norwood procedure. Preoperative risk factors include low birth weight, restrictive/intact atrial septum, obstructed pulmonary veins, ventricular dysfunction, and atrioventricular valve regurgitation. We report outcomes of the Norwood procedure in standard- and high-risk patients in the recent era.

METHODS: All patients born with hypoplastic left heart syndrome between 2006 and 2016 who underwent a Norwood procedure at our institution were included. Patient data were retrospectively reviewed, and Kaplan-Meier analysis was used to evaluate survival between groups.

RESULTS: The cohort included 177 patients. Fifty patients were determined high-risk preoperatively: low birth weight (n = 18), ventricular dysfunction/atrioventricular valve regurgitation (n = 13), intact or restrictive atrial septum/obstructed anomalous pulmonary venous return (n = 14), and multiple factors (n = 5). There were 2 (1.6%) deaths before Glenn in the standard-risk group, with a total of 10 (20%) from the high-risk groups (P < .0001). Survival at 1 year differed greatly between groups, with highest being standard risk at 89% and lowest in the intact septum/obstructed veins group at 54%. The difference between groups in long-term survival was significant (P < .001).

CONCLUSIONS: Outcomes after the Norwood procedure have improved for standard-risk patients. Those with preoperative risk factors account for most of the early deaths after the Norwood procedure. This high-risk status does not resolve after Glenn, because longer-term survival continues to diverge from the standard-risk group.

Author List

Tanem J, Rudd N, Rauscher J, Scott A, Frommelt MA, Hill GD

Author

Michele Ann Frommelt MD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin

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

Female
Follow-Up Studies
Heart Defects, Congenital
Humans
Infant, Newborn
Male
Norwood Procedures
Postoperative Period
Retrospective Studies
Risk Assessment
Risk Factors
Survival Rate
Time Factors
Treatment Outcome
Wisconsin