Factors influencing early outcome of Norwood procedure for hypoplastic left heart syndrome

Objective: The operative outcome of the Norwood procedure for hypoplastic l eft heart syndrome is still not satisfactory. Conflicting reports concern f actors associated with early Norwood procedure mortality and the reasons fo r the instability after surgery are not sufficiently understood. The purpos e of this study was to determine some perioperative factors influencing ear ly (30 days) outcome. Methods: We retrospectively analyzed a group of 30 co nsecutive children with hypoplastic left heart syndrome (aged 5-39 days) wh o underwent Norwood procedure in 1997 and 1998. The following factors were considered and statistically analyzed: operative age, birth weight, operati ve weight, serum level of bilirubin, aminotransferases. creatinine, urea, a rterial blood gasses, anatomic subgroups, ascending aorta and arch size, sy stemic to pulmonary modified right Blalock-Taussig shunt size, cardiopulmon ary circulatory arrest time, cardiopulmonary bypass time, and delayed chest closure. Eighteen patients underwent hemi-Fontan procedure with one late d eath and the modified Fontan operation was performed in 16 of them tone lat e death). Results: The early mortality was 37%. Seven deaths (64%) occurred during the first 24 h after operation. There was a significant difference between survivals and non-survivals in: birth weight (P = 0.047), operative age (P = 0.016), preoperative serum level of bilirubin (P = 0.044), and ca rdiopulmonary circulatory arrest time (P = 0.006). The other assessed facto rs were not found to be predictors of early mortality. All 16 survivals fol lowed up are in New York Heart Association class I or II. Conclusions: Anat omic and functional status of the patient, as well as procedural factors ar e related to Norwood operation early mortality. High mortality in hypoplast ic left heart syndrome after stage I surgery indicates the necessity of ass essing all factors which may determine further improvement in the outcome. (C) 2000 Elsevier Science B.V. All rights reserved.