title: Modified Norwood operation for hypoplastic left heart syndrome.
abstract: BACKGROUND
  We examined early results in infants with hypoplastic left heart syndrome undergoing the Norwood operation with perioperative use of inhaled nitric oxide and application of extracorporeal membrane oxygenation.
  
  
  METHODS
  Medical records were reviewed retrospectively.
  
  
  RESULTS
  Between April 1997 and March 2001, 50 infants underwent a modified Norwood operation for hypoplastic left heart syndrome. Mean age at operation was 7.5 +/- 5.7 days, and mean weight was 3.1 +/- 0.5 kg. Five infants had a delayed operation because of sepsis. The mean diameter of the ascending aorta by echocardiography was 3.6 +/- 1.8 mm. Ductal cannulation was used to establish cardiopulmonary bypass in all patients. Mean circulatory arrest time was 39.4 +/- 4.8 minutes. The size of the pulmonary-systemic shunt was 3.0 mm in 6 infants, 3.5 mm in 37, and 4.0 mm in 7. Infants with persistent hypoxia (partial pressure of oxygen < 30 mm Hg) received nitric oxide after they were weaned from cardiopulmonary bypass. Extracorporeal membrane oxygenation was initiated in 8 infants in the pediatric intensive care unit primarily for low cardiac output and in 8 in the operating room because of the inability to separate them from cardiopulmonary bypass. The 30-day mortality rate was 22% (11 of 50 patients), and the hospital mortality rate was 32% (16 of 50 patients). Mean follow-up was 17 months. Ten patients (20%) underwent stage-two repair, with one operative death. One survivor had a Fontan procedure, and 2 underwent heart transplantation, with one death.
  
  
  CONCLUSIONS
  Early application of extracorporeal membrane oxygenation for hemodynamic instability and selective use of nitric oxide for persistent hypoxia in the immediate postoperative period may improve survival of patients with hypoplastic left heart syndrome. Renal failure requiring hemofiltration during extracorporeal membrane oxygenation (p < 0.05) and cardiopulmonary arrest in the pediatric intensive care unit (p < 0.05) were predictors of hospital mortality.
authors.affiliation: Department of Cardiac and Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-5734, USA. davis.drinkwater@mcmail.vanderbilt.edu
authors.forename: D C
authors.initials: DC
authors.lastname: Drinkwater
authors.forename: A S
authors.initials: AS
authors.lastname: Aharon
authors.forename: S V
authors.initials: SV
authors.lastname: Quisling
authors.forename: D
authors.initials: D
authors.lastname: Dodd
authors.forename: V S
authors.initials: VS
authors.lastname: Reddy
authors.forename: A
authors.initials: A
authors.lastname: Kavanaugh-McHugh
authors.forename: T
authors.initials: T
authors.lastname: Doyle
authors.forename: N R
authors.initials: NR
authors.lastname: Patel
authors.forename: F E
authors.initials: FE
authors.lastname: Barr
authors.forename: J K
authors.initials: JK
authors.lastname: Kambam
authors.forename: T P
authors.initials: TP
authors.lastname: Graham
authors.forename: P A
authors.initials: PA
authors.lastname: Chang
mesh_terms: D000280:Administration, Inhalation; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate
chemical_list: D009569:Nitric Oxide