Single ventricle with systemic obstruction in early life: comparison of initial pulmonary artery banding versus the Norwood operation

Objectives: The outcomes of initial pulmonary artery banding (PAB) +/- coar ctation repair are compared with the Norwood operation in newborns with sin gle ventricle (SV) and systemic obstruction (SO). Methods: Between January 1987 and July 2000, 22 patients (median age, 12 days) with SV and aortic ar ch obstruction (AAO), subaortic stenosis (SAS), or both underwent surgery. Two initial surgical approaches were used: PAB +/- coarctation repair (grou p I, seven patients); Norwood type operation (group II, 15 patients). Resul ts: The overall mortality was 32% (seven of 22 patients). There was no late mortality. The mortality in group I was 43% versus 27% in group II. Recent ly, there has been no mortality following the Norwood operation in the last eight patients operated since 1995. Of the survivors, nine patients have u ndergone the Fontan operation and four patients have had the bidirectional Glenn (BDG) with no deaths. There was one repair of supravalvar aortic sten osis at the time of BDG in group II as opposed to eight reinterventions for SAS and/or AAO in four patients in group I (P = 0.01). Conclusions: PAB +/ - coarctation repair for SV and SO is associated with a high mortality and a high reoperation rate for SAS or recurrent AAO. Although the Norwood oper ation was also associated with a high mortality early on, it can now be per formed with excellent outcome. This improvement, combined with a low reinte rvention rate for SAS or AAO, suggests that the Norwood operation is likely to emerge as the procedure of choice for SV and SO. (C) 2001 Elsevier Scie nce B.V. All rights reserved.