MODIFIED NORWOOD OPERATION FOR SINGLE LEFT-VENTRICLE AND VENTRICULOARTERIAL DISCORDANCE - AN IMPROVED SURGICAL TECHNIQUE

Background. Patients with univentricular hearts and ventriculoarterial discordance with potentially obstructed systemic blood now continue t o pose difficult management problems. The goals of neonatal palliative operations are to control pulmonary blood now while avoiding pulmonar y artery distortion, to relieve systemic outflow tract obstruction, an d to avoid heart block. Methods. Between January 1987 and December 199 6, 38 patients with either tricuspid atresia or a double-inlet left ve ntricle and ventriculoarterial discordance underwent a modified Norwoo d procedure. Their mean age was 15 days, and their mean weight was 3.4 kg. Aortic arch anomalies were present in 92% of the patients. Morbid ity and mortality statistics, intraoperative data, and postoperative e chocardiograms were reviewed. Results. There were 3 early deaths (7.8% ) and 5 late deaths (13.1%). The actuarial survival rates at 1 month, 1 year, and 5 years were 89%, 82%, and 71%, respectively. Follow-up wa s complete in all children at a mean interval of 30 +/- 9 months. None of the patients had significant neoaortic valve insufficiency, and 1 patient required therapy for residual aortic arch obstruction. Nine pa tients (30% of the survivors) have undergone the hemi-Fontan procedure , and 18 patients (60%) successfully have undergone the Fontan procedu re. Conclusions. In this patient population, we recommend the modified Norwood procedure as the neonatal palliative treatment of choice. It can be performed with acceptable early morbidity and mortality, and it improves suitability for the Fontan procedure. It reliably relieves a ll levels of systemic outflow tract obstruction, controls pulmonary bl ood flow, and avoids heart block. (C) 1997 by The Society of Thoracic Surgeons.