Outcomes After Stage I Norwood Palliation in a Recently Established Program Can Achieve Results Similar to Longer Established Services

Sebastian Rimpau; Kristen Gibbons; Prem Venugopal; Nelson Alphonso; Benjamin Anderson; Kerry E Johnson; Adrian C Mattke

doi:10.1016/j.hlc.2022.02.004

Outcomes After Stage I Norwood Palliation in a Recently Established Program Can Achieve Results Similar to Longer Established Services

Heart Lung Circ. 2022 Aug;31(8):1176-1181. doi: 10.1016/j.hlc.2022.02.004. Epub 2022 Apr 7.

Authors

Sebastian Rimpau¹, Kristen Gibbons², Prem Venugopal³, Nelson Alphonso³, Benjamin Anderson⁴, Kerry E Johnson⁵, Adrian C Mattke⁶

Affiliations

¹ Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Qld, Australia; University of Queensland, School of Clinical Medicine, Brisbane, Qld, Australia.
² Paediatric Critical Care Research Group (PCCRG), The University of Queensland, Brisbane, Qld, Australia.
³ Paediatric Critical Care Research Group (PCCRG), The University of Queensland, Brisbane, Qld, Australia; Department of Paediatric Cardiothoracic Surgery, Queensland Children's Hospital, Brisbane, Qld, Australia; Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Qld, Australia.
⁴ University of Queensland, School of Clinical Medicine, Brisbane, Qld, Australia; Paediatric Critical Care Research Group (PCCRG), The University of Queensland, Brisbane, Qld, Australia; Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Qld, Australia.
⁵ Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Qld, Australia; Paediatric Critical Care Research Group (PCCRG), The University of Queensland, Brisbane, Qld, Australia.
⁶ Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Qld, Australia; University of Queensland, School of Clinical Medicine, Brisbane, Qld, Australia; Paediatric Critical Care Research Group (PCCRG), The University of Queensland, Brisbane, Qld, Australia. Electronic address: Adrian.mattke@health.qld.gov.au.

PMID: 35398006
DOI: 10.1016/j.hlc.2022.02.004

Abstract

Background: Infants with hypoplastic left heart syndrome (HLHS) or similar single ventricle cardiac lesions require a three-stage surgical approach, the first step being the Stage I Norwood procedure. The Queensland Children's Hospital (QCH) in Australia is a tertiary hospital providing the only cardiac surgical service to children in Queensland and northern New South Wales.

Objective: To review the centre's outcomes of Norwood procedures performed in the last 6 years.

Materials and methods: We retrospectively evaluated all infants undergoing the stage I Norwood procedure between January 2015 and August 2021. Mortality, intensive care length of stay, events of cardiac arrest following surgery and duration of mechanical ventilation were calculated and analysed for subgroups depending on type of pulmonary shunt type (right-ventricle-to-pulmonary-artery shunt [RVPAS] vs the modified Blalock-Taussig shunt [MBTS]).

Results: Forty-nine (49) patients were included. Overall survival to stage two operation (Glenn) was 90%. Both shunts were used evenly with the RVPA conduit preferred for HLHS and the MBTS largely chosen for hypoplastic left heart variants. In univariable analysis there was no difference in cardiac arrest or mortality rate for the patient with a RVPAS compared to the patient with a MBTS.

Conclusion: We show that a recently established Norwood program can achieve results that are comparable to those reported by longer established centres, and the international literature.

Keywords: Children; Clipped Sano shunt; Hypoplastic left heart syndrome; Modified Blalock-Taussig shunt; Norwood Procedure; RV-PA shunt.

MeSH terms

Child
Heart Arrest*
Heart Ventricles / surgery
Humans
Hypoplastic Left Heart Syndrome* / surgery
Infant
Norwood Procedures* / methods
Pulmonary Artery / surgery
Retrospective Studies
Treatment Outcome