Current outcomes and risk factors for the Norwood procedure

Stasik, Chad N.; Goldberg, Caren S.; Bove, Edward L.; Devaney, Eric J.; Ohye, Richard G.

doi:10.1016/j.jtcvs.2005.09.030

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 131, Issue 2 , Pages 412-417, February 2006

Current outcomes and risk factors for the Norwood procedure

Read at the Thirty-first Annual Meeting of The Western Thoracic Surgical Association, Victoria, BC, Canada, June 22-25, 2005.

Chad N. Stasik, MD
- Division of Pediatric Cardiovascular Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich
Caren S. Goldberg, MD
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan Medical School, Ann Arbor, Mich
Edward L. Bove, MD
- Division of Pediatric Cardiovascular Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan Medical School, Ann Arbor, Mich
Eric J. Devaney, MD
- Division of Pediatric Cardiovascular Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich
Richard G. Ohye, MD
- Division of Pediatric Cardiovascular Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich
- Address for reprints: Richard G. Ohye, MD, F7830 Mott Hospital, 1500 East Medical Center Dr, Ann Arbor, MI 48109-0223

Received 26 June 2005; received in revised form 25 August 2005; accepted 8 September 2005. published online 13 January 2006.

Objective

Tremendous strides have been made in the outcomes for hypoplastic left heart syndrome and other functional single-ventricle malformations over the past 25 years. This progress relates primarily to improvements in survival for patients undergoing the Norwood procedure. Previous reports on risk factors have been on smaller groups of patients or collected over relatively long periods of time, during which management has evolved. We analyzed our current results for the Norwood procedure with attention to risk factors for poor outcome.

Methods

A single-institution review of all patients undergoing a Norwood procedure for a single-ventricle malformation from May 1, 2001, through April 30, 2003, was performed. Patient demographics, anatomy, clinical condition, associated anomalies, operative details, and outcomes were recorded.

Results

Of the 111 patients, there were 23 (21%) hospital deaths. Univariate analysis revealed noncardiac abnormalities (genetic or significant extracardiac diagnosis, P = .0018), gestational age (P = .03), diagnosis of unbalanced atrioventricular septal defect (P = .017), and weight of less than 2.5 kg (P = .0072) to be related to hospital death. On multivariate analysis, only weight of less than 2.5 kg and noncardiac abnormalities were found to be independent risk factors. Patients with either of these characteristics had a hospital survival of 52% (12/23), whereas those at standard risk had a survival of 86% (76/88).

Conclusions

Although improvements in management might have lessened the effect of some of the traditionally reported risk factors related to variations in the cardiovascular anatomy, noncardiac abnormalities and low birth weight remain as a future challenge for the physician caring for the patient with single-ventricle physiology.

CTSNet classification: 21

Abbreviations and Acronyms: CPB, cardiopulmonary bypass, DHCA, deep hypothermic circulatory arrest, FSV, functional single ventricle, HLHS, hypoplastic left heart syndrome, RCP, regional cerebral perfusion