[Short and medium-term results of the Norwood intervention (first stage)].
We report the short and mid-term results of the Norwood procedure (Stage one) in 20 patients with hypoplastic left heart syndrome or univentricular heart with aortic obstruction. Seven patients were prenatally diagnosed. Preoperatively there was obstruction to pulmonary venous return in 6 cases, a mild to moderate tricuspid regurgitation in 6 cases, and 11 patients were supported by mechanical ventilation with multiorgan failure in 5 cases. The surgery was performed under cardiopulmonary bypass at a mean age and weight of 12.9 days and 3 kg, respectively. Nine patients (45%) died within 30 days postoperatively, whereas 5 had delayed sternal closure. The mean duration of mechanical ventilation and ICU stay were 5.7 and 11 days, respectively. Two patients were reoperated for bronchial compression and tracheotomy. Systemic venous thrombosis occurred in 5 patients. In multivariate analysis, an older age at surgery was correlated with postoperative hospital death (p = 0.03). Among the 11 patients discharged home after Stage one procedure, 5 patients underwent balloon dilation for recoarctation and one patient died at home. A bidirectional cavopulmonary anastomosis was performed in 8 patients at a mean age of 0.76 year, with one postoperative death. After a mean follow-up of 1 year (+/- 1.97 years), the 9 remaining patients are all in NYHA class I, at a mean age of 2.2 years. Their mean transcutaneous saturation is 81%. The Norwood procedure (Stage one) is associated with high hospital mortality. However, the functional status of the survivors is correct, like in patients with other type of univentricular hearts. Moreover, although the causes of death in our patients are often not clarified, other studies show that the leading causes of deaths in our patients are often not clarified, other studies show that the leading causes of death in those patients are correctable. In conclusion, the option of a Norwood procedure (Stage one) should be proposed in patients with hypoplastic left heart syndrome (or variant).
Fraisse
A
A
Unité de cardiologie pédiatrique, hôpital d'enfants de la Timone, 264, rue Saint-Pierre, 13385 Marseille.
Chetaille
P
P
Kreitmann
B
B
Gaudart
J
J
Nassi
C
C
Tauzin
L
L
Guillaumont
S
S
Camboulives
J
J
Métras
D
D
D000714:Anastomosis, Surgical; D002423:Cause of Death; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000473:pathology / Q000601:surgery*; D007231:Infant, Newborn; D007362:Intensive Care Units; D007902:Length of Stay; D008168:Lung / Q000098:blood supply; D008297:Male; D012039:Regional Blood Flow; D012086:Reoperation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D018785:Tricuspid Atresia / Q000473:pathology / Q000601:surgery*; D020246:Venous Thrombosis / Q000209:etiology