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Ann Thorac Surg 2001;72:1349-1353
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Evolving strategies and improving outcomes of the modified Norwood procedure: a 10-year single-institution experience

Anthony Azakie, MDa, Sandra L. Merklinger, MNa, Brian W. McCrindle, MD, FRCP(C)b, Glen S. Van Arsdell, MDa, Kyong-Jin Lee, MD, FRCP(C)b, Lee N. Benson, MD, FRCP(C)b, John G. Coles, MDa, William G. Williams, MDa

a Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada
b Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada

Accepted for publication April 27, 2001.

Address reprint requests to Dr Williams, Division of Cardiovascular Surgery, The Hospital for Sick Children, 555 University Ave, Room 1525, Toronto, ON M5G 1X8, Canada
e-mail: tony.azakie{at}utoronto.ca

Background. This study reviews our 10-year experience with the modified Norwood procedure to determine its early and midterm outcomes. The focus is on the impact of evolving management strategies and accumulated institutional experience.

Methods. A modified Norwood operation was performed in 171 infants over a 10-year period. Sixty-eight percent of the infants were male, the median age at operation was 6 days (range 1 to 175 days), and the median weight was 3.3 kg (range 1.7 to 4.8 kg). The 10-year period was divided into three eras: era I; 1990 through 1993; era II; 1994 through 1997; and era III; 1998 into 2000. Outcomes and risk factors for mortality were sought.

Results. Hypoplastic left heart syndrome or a variant was the primary diagnosis in 118 infants (69%). The overall 5-year survival rate was 43%. Multivariate analysis revealed that only need of preoperative ventilatory support, earlier date of operation, and lower weight at operation were significant independent predictors of increased time-related mortality. Morphologic features such as a diagnosis other than hypoplastic left heart syndrome, ascending aortic size, and noncardiac anomalies were not significantly associated with an increased risk of death. The hospital survival rate for stage-one palliation in era III was 82%, significantly better than that in the preceding eras (p < 0.001). Attrition between stages one and two accounted for a 15% mortality rate among hospital survivors.

Conclusions. With increasing experience and improvements in perioperative care and surgical technique, good outcomes can be expected for the first-stage modified Norwood procedure. Greater monitoring of patients in the interstage period may reduce interval mortality and improve overall survival.




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