title: Staged biventricular repair for neonates with left ventricular outflow tract obstruction, ventricular septal defect, and aortic arch obstruction.
abstract: BACKGROUND
  The purpose of this study is to evaluate clinical outcomes of neonates who underwent a Norwood operation as a first step of a planned biventricular repair and the impact of associated risk factors.
  
  
  METHODS
  A retrospective cohort study was performed on all neonates (n = 44) undergoing the Norwood operation as the first stage of a biventricular (Norwood-Rastelli) repair from January 2000 to December 2012 at a single center. Multivariable analysis was performed to identify predictors of survival.
  
  
  RESULTS
  Stage one mortality was 9%. The interstage survival for nonsyndromic and syndromic patients was 100% versus 46%, respectively (p < 0.001). Twenty-four patients (55%) underwent biventricular completion repair with no mortality. Freedom from reintervention after biventricular completion was 53% at 6 years. The overall survival for nonsyndromic patients versus syndromic patients was 86% versus 43%, respectively (p = 0.01). Genetic syndromes and prematurity were significant predictors of interstage mortality on multivariable analysis.
  
  
  CONCLUSIONS
  Staged biventricular repair for patients with complex left ventricular outflow tract obstruction, ventricular septal defect, and aortic arch obstruction can be achieved with excellent outcomes for neonates without genetic syndromes. The staged approach is associated with longer time to reintervention after the biventricular completion.
authors.affiliation: Madinah Cardiac Center, Taibah University, Madinah, Saudi Arabia. Electronic address: mshihata@gmail.com.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Shihata
authors.affiliation: Heart Institute for Children, Advocate Children's Hospital, Oak Lawn, Illinois.
authors.forename: Chawki
authors.initials: C
authors.lastname: El-Zein
authors.affiliation: Heart Institute for Children, Advocate Children's Hospital, Oak Lawn, Illinois.
authors.forename: Katie
authors.initials: K
authors.lastname: Wittle
authors.affiliation: Heart Institute for Children, Advocate Children's Hospital, Oak Lawn, Illinois.
authors.forename: Tarek
authors.initials: T
authors.lastname: Husayni
authors.affiliation: Heart Institute for Children, Advocate Children's Hospital, Oak Lawn, Illinois.
authors.forename: Michel
authors.initials: M
authors.lastname: Ilbawi
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery*; D001017:Aortic Coarctation / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures / Q000379:methods*; D012189:Retrospective Studies; D014694:Ventricular Outflow Obstruction / Q000601:surgery*