title: Improving surgical outcome following the Norwood procedure.
abstract: BACKGROUND
  The Norwood procedure consists of three palliative operations, performed in neonates with hypoplastic left heart syndrome. Especially the first stage (Norwood I) is associated with the highest mortality rates in paediatric cardiac surgery (up to 25%). During surgery, the aorta is reconstructed and a systemic-to-pulmonary shunt is applied. Originally the modified Blalock-Taussig shunt was used, but recently the right-ventricle-to-pulmonary-artery shunt is increasingly being employed. We reviewed the results of our operative strategy, where an individualised choice of shunt is made. Furthermore, attempts to reduce interstage mortality (between Norwood I and II) were assessed.
  
  
  METHODS
  All neonates who underwent Norwood stage I palliation from August 2004 until November 2010 were included in this retrospective analysis. Mortality rates and management strategies were compared.
  
  
  RESULTS
  Thirty-six patients were available for analysis. Overall 30-day mortality was 5.6% (2 patients) and interstage mortality after discharge was 14% (5 patients). In 2006, a novel clinical protocol was introduced, aimed at reduction of mortality during the interstage period. This resulted in reduction of interstage mortality from 23% to 9% (3 of 13 infants, versus 2 of 23), with a cumulative survival of 82% (maximum follow-up 4 years).
  
  
  CONCLUSIONS
  Early surgical results following the Norwood procedure using an individualised shunt choice are favourable.
authors.affiliation: Department of Pediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508, AB, Utrecht, the Netherlands, s.o.algra@umcutrecht.nl.
authors.forename: S O
authors.initials: SO
authors.lastname: Algra
authors.forename: J M P J
authors.initials: JM
authors.lastname: Breur
authors.forename: F C M
authors.initials: FC
authors.lastname: Evens
authors.forename: F
authors.initials: F
authors.lastname: de Roo
authors.forename: P H
authors.initials: PH
authors.lastname: Schoof
authors.forename: F
authors.initials: F
authors.lastname: Haas