Outcomes, mortality risk factors, and functional status post-Norwood: A single-center study

Alaa Aljiffry; Ashley Harriott; Shayli Patel; Amy Scheel; Alan Amedi; Sean Evans; Yijin Xiang; Amanda Harding; Subhadra Shashidharan; Asaad G Beshish

doi:10.1016/j.ijcchd.2024.100533

Outcomes, mortality risk factors, and functional status post-Norwood: A single-center study

Int J Cardiol Congenit Heart Dis. 2024 Jul 26:17:100533. doi: 10.1016/j.ijcchd.2024.100533. eCollection 2024 Sep.

Authors

Affiliations

¹ Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
² Emory University School of Medicine, Atlanta, GA, USA.
³ Biostatistician and Data Analyst, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
⁴ Senior Pediatric Cardiac Sonographer, Children's Healthcare of Atlanta, Atlanta, GA, USA.
⁵ Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.

Abstract

Background: The Norwood operation (NO) for infants with univentricular physiology has high interstage mortality. This study evaluated outcomes and risk factors for mortality following NO.

Methods: Retrospective single-center study of patients undergoing NO from 2010 to 2020. Analysis used appropriate statistics.

Results: Of 269 patients undergoing NO, 213 (79.2 %) survived to discharge. Non-survivors had longer bypass times, delayed sternal closure, required nitric oxide, higher vasoactive scores, required post-operative catheterization, Extracorporeal Life Support (ECLS), and longer ventilation (p < 0.05). Logistic regression showed moderate-severe atrioventricular valve regurgitation on intraoperative TEE (OR 2.6), requiring nitric oxide (OR 2.63), delayed sternal closure (OR 2.94), post-operative catheterization (OR 10.48), and ECLS (OR 14.54) increased mortality odds (p < 0.05). Multivariable analysis confirmed catheterization (aOR 10.48) and ECLS (aOR 14.54) as significant predictors. Of survivors, 26 (12.3 %) developed new morbidity, 9 (4.2 %) had unfavorable outcomes. Functional status improved from 6.0 to 8.04, mainly in feeding and respiratory domains (p < 0.0001).

Conclusions: Norwood survival was 79.2 %. Requiring post-operative catheterization and ECLS significantly increased mortality risk. Multicenter evaluation of these modifiable risk factors is needed to improve outcomes in this high-risk population.

Keywords: Functional status scale (FSS); New-morbidity; Norwood operation; Unfavorable outcome; Univentricular physiology patients.