title: Unplanned cardiac reoperations and interventions during long-term follow-up after the Norwood procedure†.
abstract: OBJECTIVE
  Patients with hypoplastic left heart syndrome or related malformations are predominantly treated with a 3-stage palliation. Anatomic or physiologic problems can lead to unplanned additional surgical or catheter interventions during single ventricle palliation. Changes in operative technique may have an impact on the reoperation rate.
  
  
  METHODS
  Between 1997 and 2014, 317 Norwood procedures were performed at our centre. A retrospective single centre investigation was carried out concerning incidence, timing, indication and type of unplanned interstage cardiac reoperations and catheter interventions during follow-up of Norwood patients. Patients were followed from birth until the end of 2015. Cardiac procedures taking place at the time of the bidirectional Glenn or Fontan procedure or heart transplantation were not included.
  
  
  RESULTS
  Sixty-five of the Norwood patients (20.5%) had at least one additional surgical cardiac procedure. Nine patients (2.8%) needed open procedures prior to the Norwood operations, 11.0% had procedures in the interstage I, 3.5% in the interstage II and 9.1% of the Fontan patients had cardiac reoperations afterwards. Main indications for unplanned surgery were insufficient pulmonary perfusion and tricuspid regurgitation. Eighty-one patients (25.6%) had at least one interstage catheter intervention during follow-up mainly addressing stenosis of the pulmonary arteries, aortic arch stenosis or aortopulmonary collaterals.
  
  
  CONCLUSIONS
  The number of unplanned reoperations and interventions during staged palliation is remarkably high showing surgical peaks in the interstage I and after the Fontan procedure and an interventional peak in the interstage II. Thorough early information of the parents about possibly anticipated additional procedures is necessary.
authors.affiliation: Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria.
authors.forename: Eva
authors.initials: E
authors.lastname: Sames-Dolzer
authors.affiliation: Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria.
authors.forename: Gregor
authors.initials: G
authors.lastname: Gierlinger
authors.affiliation: Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria.
authors.forename: Michaela
authors.initials: M
authors.lastname: Kreuzer
authors.affiliation: Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Schrempf
authors.affiliation: Department of Pediatric Cardiology, Kepler University Hospital, Linz, Austria.
authors.forename: Roland
authors.initials: R
authors.lastname: Gitter
authors.affiliation: Department of Pediatric Cardiology, Kepler University Hospital, Linz, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Prandstetter
authors.affiliation: Department of Pediatric Cardiology, Kepler University Hospital, Linz, Austria.
authors.forename: Gerald
authors.initials: G
authors.lastname: Tulzer
authors.affiliation: Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Mair
mesh_terms: D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hypoplastic left heart syndrome ; Norwood procedures ; Reoperation rate ; Staged palliation