Experience With the Norwood Operation for Hypoplastic Left Heart Syndrome

• Published in: Revista española de cardiologia 2007-07, Vol.60 (7), p.732-738
• Main Authors: García-Hernández, Juan A., González-Rodríguez, Juan D., Martínez-López, Adoración I., Canalejo-González, David, Romero-Parreño, Antonio, de Soto, José Santos, Loscertales-Abril, Mercedes, Cayuela-Domínguez, Aurelio, Fournier-Carazo, Mauro Gil
• Format: Article
• Language: eng ; spa
• Subjects: Cardiac Surgical Procedures - methods; Cardiopatía congénita; Cardiopulmonary bypass; Circulación extra-corpórea; Congenital heart disease; Hospital Mortality; Humans; Hypoplastic left heart syndrome; Hypoplastic Left Heart Syndrome - mortality; Hypoplastic Left Heart Syndrome - surgery; Infant, Newborn; Norwood; Norwood operation; Prognosis; Prospective Studies; Risk Factors; Síndrome del corazón izquierdo hipoplásico
• ISSN: 1885-5857; 1885-5857; 1579-2242
• DOI: 10.1016/S1885-5857(08)60009-2

To describe our experience and to identify risk factors for in-hospital mortality. Between October 1991 and June 2005, 42 children underwent the Norwood procedure. In the first 30 patients, pulmonary circulation was established using a modified Blalock-Taussig shunt (Group 1), while a right ventricle to pulmonary artery conduit was used in the remaining 12 (Group 2). Preoperative anatomic features and procedural factors were analyzed with respect to their impact on mortality. Postoperatively, data were collected on arterial blood pressure, arterial and venous oxygen saturation, arterial pH, venous pCO 2, the PaO 2/FiO 2 ratio, tissue oxygen extraction, and dead space fraction. The association between each individual variable and mortality was investigated. Thirty patients (71.4%) had both aortic and mitral atresia, 8 (19%) had either aortic or mitral atresia, and 4 (9.5%) had no valvular atresia. There was no statistically significant difference in postoperative mortality between the groups 1 and 2 (12/22 [54.5%] vs 7/12 [58.3%]; P=.56). The only significant risk factor for inhospital mortality was a longer cardiopulmonary bypass time (P=.01) and, for intraoperative mortality, primary rather than delayed sternal closure (P=.004). Venous pCO 2, the mean dead space fraction, and tissue oxygen extraction all tended to be higher among infants who died, but the difference was not statistically significant. Use of a right ventricle to pulmonary artery conduit did not improve postoperative survival. Both a long cardiopulmonary bypass time and primary sternal closure were associated with increased mortality. Describir nuestra experiencia e identificar factores de riesgo de mortalidad hospitalaria. Entre octubre de 1991 y junio de 2005 intervinimos a 42 niños con la técnica de Norwood. Los 30 primeros recibieron una fístula de Blalock-Taussig (grupo 1) y los 12 restantes, un conducto entre el ventrículo derecho y la arteria pulmonar (grupo 2). Se analizaron los factores anatómicos y de la técnica con respecto a la mortalidad. Se recogieron variables del postoperatorio, incluidas la presión arterial, la saturación arterial y venosa de oxígeno, el pH arterial, la pCO 2 venosa, la relación PaO 2/FiO 2, la extracción tisular de oxígeno y el espacio muerto, para estudiar su asociación con la mortalidad. En total, 30 (71,4%) pacientes tenían atresia aórtica y mitral; 8 (19%) tenían atresia aórtica o mitral y 4 (9,5%) no tenían atresia. No hubo diferencias significativas