CAUSES OF DEATH AFTER THE MODIFIED NORWOOD-PROCEDURE - A STUDY OF 122POSTMORTEM CASES

Background. Although the results of the modified Norwood procedure as palliation for the hypoplastic left heart syndrome have improved consi derably, in-hospital mortality remains high (28% to 46%). Methods. To establish the causes of death and consider their therapeutic applicati ons, we reviewed our pathology experience from 1980 to 1995, inclusive , regarding 122 patients who died after undergoing the Norwood procedu re. Results. The most important causes of death were found to be impai rment of coronary perfusion (33 patients, 27%), excessive pulmonary bl ood flow (23 patients, 19%), obstruction of pulmonary arterial blood f low (21 patients, 17%), neoaortic obstruction (17 patients, 14%), righ t ventricular failure (16 patients, 13%), bleeding (9 patients, 7%), i nfection (6 patients, 5%), tricuspid or common atrioventricular valve dysfunction (6 patients, 5%), sudden death from presumed arrhythmias ( 6 patients, 5%), and necrotizing enterocolitis (3 patients, 3%). In 26 patients (21%), more than one factor appeared responsible for death. Conclusions. The leading causes of death after the Norwood procedure w ere found to be largely correctable surgical technical problems associ ated with perfusion of the lungs (36%), of the myocardium (27%), and o f the systemic organs (14%). (C) 1997 by The Society of Thoracic Surge ons.