title: Fifteen-year single-center experience with the Norwood operation for complex lesions with single-ventricle physiology compared with hypoplastic left heart syndrome.
abstract: OBJECTIVE
  The Norwood procedure, the first surgical step of staged palliation for hypoplastic left heart syndrome, is also applied for other complex single-ventricle lesions with systemic outflow tract obstruction or aortic arch hypoplasia. We reviewed our 15-year institutional experience with the Norwood procedure for patients with and without hypoplastic left heart syndrome.
  
  
  METHODS
  A total of 41 patients without hypoplastic left heart syndrome and 212 patients with hypoplastic left heart syndrome who underwent a Norwood procedure between January 1996 and December 2010 were enrolled. Full medical records were reviewed to assess the determinants of outcome.
  
  
  RESULTS
  Early failure (death or cardiac transplantation) was 7% in patients without hypoplastic left heart syndrome and 13% in patients with hypoplastic left heart syndrome (P = .29). Frequency of postoperative complications, duration of postoperative ventilation, and length of vasoactive drug treatment were not different between groups. Transplant-free survival until the second operative step trended to be higher for patients without hypoplastic left heart syndrome (92% vs 80%, P = .067). Recurrent aortic arch obstruction was more common in patients without hypoplastic left heart syndrome (15/39 vs 32/171, P = .008), but there were 4 patients with stenosis of the proximal aortic arch. In subsequent procedures, 31 patients without hypoplastic left heart syndrome underwent superior cavopulmonary anastomosis and 5 biventricular repair. Overall transplant-free survival was not different between groups (P = .119) but trended to be higher in patients with a systemic or substantial left ventricle remnant contributing to cardiac output (P = .082).
  
  
  CONCLUSIONS
  Early and long-term survivals and postoperative complications were similar between patients with and without hypoplastic left heart syndrome undergoing a Norwood operation. Recurrent aortic arch obstruction was common in both groups but more prevalent in patients without hypoplastic left heart syndrome.
authors.affiliation: Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany. jan.hansen@uk-sh.de
authors.forename: Jan H
authors.initials: JH
authors.lastname: Hansen
authors.forename: Colin
authors.initials: C
authors.lastname: Petko
authors.forename: Gero
authors.initials: G
authors.lastname: Bauer
authors.forename: Inga
authors.initials: I
authors.lastname: Voges
authors.forename: Hans-Heiner
authors.initials: HH
authors.lastname: Kramer
authors.forename: Jens
authors.initials: J
authors.lastname: Scheewe
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery; D058366:Blalock-Taussig Procedure; D016009:Chi-Square Distribution; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000401:mortality / Q000601:surgery; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D058327:Norwood Procedures / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome