Outcome of the Modified Norwood Procedure: 7 Years of Experience from a Single Institution.
- Author:
Hyungtae KIM
1
;
Si Chan SUNG
;
Si Ho KIM
;
Mi Ju BAE
;
Hyoung Doo LEE
;
Ji Ae PARK
;
Yun Hee CHANG
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Korea. scsung21@hanmail.net
- Publication Type:Original Article
- Keywords:
Congenital heart disease (CHD);
Hypoplastic left heart disease;
Norwood procedure
- MeSH:
Aneurysm;
Cardiovascular Abnormalities;
Deglutition Disorders;
Follow-Up Studies;
Fontan Procedure;
Hospital Mortality;
Humans;
Hypoplastic Left Heart Syndrome;
Male;
Norwood Procedures;
Pulmonary Artery;
Risk Factors;
Subclavian Artery;
Survival Rate
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2010;43(4):364-374
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: We assessed the early and mid-term results of the modified Norwood procedure for first-stage palliation of hypoplastic left heart syndrome (HLHS) and its variants to identify the risk factors for hospital mortality. MATERIAL AND METHOD: Between March, 2003, and December, 2009, 23 patients (18 males and 5 females) with HLHS or variants underwent the modified Norwood procedure. The age at operation ranged from 3 to 60 days (mean, 11.7+/-13.2 days) and weight at operation ranged from 2.2 to 4.8 kg (mean, 3.17+/-0.52 kg). We used a modified technique that spared the anterior wall of the main pulmonary artery in 20 patients. The sources of pulmonary blood flow were RV-PA conduit in 15 patients (group I) and RMBTS in 8 (group II). Follow-up was completed in 19 patients (19/20, 95%) in our hospital (mean 26.0+/-22.8 months). RESULT: Early death occurred in 3 patients (3/23, 13%), of whom 2 had TAPVC. Fourteen patients underwent subsequent bidirectional cavopulmonary connection (BCPC, stage 2) and seven underwent the Fontan operation (stage 3). Three patients died between stages, 2 before stage 2 and one before stage 3. The estimated 1-year and 5-year survival rates were 78% and 69%, respectively. On multivariate regression analysis, aberrant right subclavian artery (RSCA) and associated total anomalous pulmonary venous connection (TAPVC) were risk factors for hospital mortality after stage 1 Norwood procedure. CONCLUSION: HLHS and its variants can be palliated by the modified Norwood procedure with low operative mortality. Total anomalous pulmonary venous connection adversely affects the survival after a stage 1 Norwood procedure, and interstage mortality rates need to be improved.
