Hypoplastic left heart syndrome: the influence of surgical strategy on outcomes.
OBJECTIVE
To report a surgical strategy for the Norwood procedure in the hypoplastic left heart syndrome (HLHS) that enables short hypothermic circulatory arrest time and aortic arch reconstruction with autologous pericardium patch, and to compare the results of the modified Blalock-Taussig (mBT) shunt with the right ventricle-to-pulmonary artery (RV-PA) conduit procedures as the source of pulmonary blood flow.


METHODS
Retrospective study of 71 newborns with HLHS consecutively operated between March, 1999 and February, 2006. One technique for reconstruction of the neoaorta and two different techniques for reestablishment of the pulmonary blood flow were used: the mBT shunt in the first 37 newborns and RV-PA conduit in the last 34. Cannulation of the ductus arteriosus for arterial perfusion was the main part of the surgical strategy to reduce the hypothermic circulatory arrest time.


RESULTS
In-hospital survival for the entire cohort was 74.64%, or 67.57% and 82.35% for the mBT shunt and RV-PA conduit groups, respectively (p=0.1808). Mortality rates between the first and second palliation stages were 40% and 4.4% for the mBT shunt and RV-PA conduit groups, respectively (p=0.0054). Hypothermic circulatory arrest times were 45.79+/-1.99 min and 36.62+/-1.62 min (p=0.0012), respectively. Late coarctation of the aorta occurred in five patients (7.2%).


CONCLUSIONS
This surgical strategy resulted in short circulatory arrest time, low mortality and favorable morphology of the neoaorta, with low incidence of late coarctation of the aorta. The higher rate of survival to first palliation stage with the RV-PA conduit was not significant, but interstage mortality was statistically lower when compared with the modified Blalock-Taussig shunt procedure.
Silva
José Pedro da
JP
Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil. clinicajpdasilva@uol.com.br
Fonseca
Luciana da
Ld
Baumgratz
José Francisco
JF
Castro
Rodrigo Moreira
RM
Franchi
Sonia Meiken
SM
Sylos
Cristina de
Cd
Grassi
Liliane M G Pozzi
LM
Cattani
César Augusto M
CA
Lopes
Lílian Maria
LM
Vila
José Henrique Andrade
JH
D000714:Anastomosis, Surgical / Q000379:methods; D001011:Aorta / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D003627:Data Interpretation, Statistical; D005260:Female; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007231:Infant, Newborn; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors