Thorac Cardiovasc Surg 2016; 64 - OP62
DOI: 10.1055/s-0036-1571519

Single Center Experience with 242 Consecutive Patients before and after Norwood Operation: Outcome in Different Eras

L. Duebener 1, H. Blaschczok 1, A. Ksellmann 2, E. Schindler 3, M. Schneider 4, V. Hraska 1, B. Asfour 1
  • 1Deutsches Kinderherzzentrum St. Augustin, Abt. für Kinderherzchirurgie, Sankt Augustin, Germany
  • 2Deutsches Kinderherzzentrum St. Augustin, Abt. für Kinderherz-Intensivmedizin, Sankt Augustin, Germany
  • 3Deutsches Kinderherzzentrum St. Augustin, Abt. für Anästhesiologie, Sankt Augustin, Germany
  • 4Deutsches Kinderherzzentrum St. Augustin, Abt. für Kardiologie, Sankt Augustin, Germany

Objectives: There is constant evolution of management strategies to improve outcome in Norwood patients. It is unclear if these strategies have any beneficial effect on outcome. Therefore, the goal of this study was to analyze the outcome data of our Norwood Patients in consecutive eras after treatment modifications.

Methods: From January 2002 to March 2015 a total 242 patients underwent a Norwood procedure in our institution. Hypoplastic left heart syndrome was the underlying diagnosis in 91% of these patients. The patients were divided in three groups according to era and treatment strategy. In Group I (n = 83, 2002–2008) there was a frequent use of Sano shunts. In Group II (n = 79, 2008–2011) predominantly intraop. BT shunts and postop. β-blockers were used. In the most recent Group III (n = 80, 2011–2015) we relatively commonly performed bilateral pulmonary artery bandings in high-risk patients. Postoperatively mainly ACE inhibitors are given now. The comprehensive Aristotle score to estimate the surgical risk was 17.4 ± 2.0 vs 18.1 ± 3.0 vs 18.5 ± 1.6 in group I, II and III, respectively (p = ns).

Results: Median patient age at Norwood operation was approximately one week (6, 7 and 7 days in groups I, II and III). In-hospital mortality was 14% (group I) vs 8% (group II) vs 10% (group III). The interstage mortality was 4%, 11% and 5% in the groups I, II, and III, respectively. None of the differences were statistically significant. After the bidirectional glenn operation the survival was excellent in all groups. In none of the groups major neurological injuries occurred.

Conclusions: Patients before and after Norwood Operation continue to be a challenging group of patients. Combined in-hospital and interstage mortality remain fairly constant in shunt-dependent Norwood patients despite changes in treatment strategies. However, we found the use of bilateral pulmonary artery bandings useful in high-risk patients before the Norwood operation.