BACKGROUND: To determine and compare outcome of the modified Norwood procedure using either a systemic to pulmonary artery (SPA) shunt or right ventricle to pulmonary artery (RV-PA) conduit in a consecutive series of neonates at a single institution. METHODS: The medical records were retrospectively examined for preoperative demographic and echocardiographic data, operative variables, and postoperative clinical and hemodynamic data. From November 2001 to March 2003, 21 neonates had a modified Norwood procedure (SPA shunt, n = 8; RV-PA conduit, n = 13) at a median age of 5 days (range 1 to 18 days) and a median weight of 2.9 kg (range 1.7 to 4.1 kg). Of the 21 infants, 12 were considered high risk due to presence of low birth weight (n = 4), extracardiac or genetic anomalies (n = 5) or obstruction to pulmonary venous return (n = 5). Nine "high risk" infants were in the RV-PA conduit group. RESULTS: Overall Norwood operation survival was 90% (19/21) and did not differ between groups. There were 2/19 interstage deaths and Kaplan-Meier survival at 1 year is 79%. Neonates in the RV-PA conduit group had significantly higher diastolic blood pressures at 1, 6, and 24 hours postoperatively (p < 0.05). Neonates in the SPA shunt group had significantly higher heart rates at 1 hour postoperatively (p < 0.05) than those in the RV-PA group. There was a trend to higher number of ventilatory interventions to balance Qp:Qs in the SPA shunt group (p = 0.06). CONCLUSIONS: In a relatively high-risk group, neonates having an RV-PA conduit as part of the Norwood procedure have favorable postoperative hemodynamics and a good likelihood of stage I survival.
BACKGROUND: To determine and compare outcome of the modified Norwood procedure using either a systemic to pulmonary artery (SPA) shunt or right ventricle to pulmonary artery (RV-PA) conduit in a consecutive series of neonates at a single institution. METHODS: The medical records were retrospectively examined for preoperative demographic and echocardiographic data, operative variables, and postoperative clinical and hemodynamic data. From November 2001 to March 2003, 21 neonates had a modified Norwood procedure (SPA shunt, n = 8; RV-PA conduit, n = 13) at a median age of 5 days (range 1 to 18 days) and a median weight of 2.9 kg (range 1.7 to 4.1 kg). Of the 21 infants, 12 were considered high risk due to presence of low birth weight (n = 4), extracardiac or genetic anomalies (n = 5) or obstruction to pulmonary venous return (n = 5). Nine "high risk" infants were in the RV-PA conduit group. RESULTS: Overall Norwood operation survival was 90% (19/21) and did not differ between groups. There were 2/19 interstage deaths and Kaplan-Meier survival at 1 year is 79%. Neonates in the RV-PA conduit group had significantly higher diastolic blood pressures at 1, 6, and 24 hours postoperatively (p < 0.05). Neonates in the SPA shunt group had significantly higher heart rates at 1 hour postoperatively (p < 0.05) than those in the RV-PA group. There was a trend to higher number of ventilatory interventions to balance Qp:Qs in the SPA shunt group (p = 0.06). CONCLUSIONS: In a relatively high-risk group, neonates having an RV-PA conduit as part of the Norwood procedure have favorable postoperative hemodynamics and a good likelihood of stage I survival.
Authors: Richard G Ohye; Lynn A Sleeper; Lynn Mahony; Jane W Newburger; Gail D Pearson; Minmin Lu; Caren S Goldberg; Sarah Tabbutt; Peter C Frommelt; Nancy S Ghanayem; Peter C Laussen; John F Rhodes; Alan B Lewis; Seema Mital; Chitra Ravishankar; Ismee A Williams; Carolyn Dunbar-Masterson; Andrew M Atz; Steven Colan; L LuAnn Minich; Christian Pizarro; Kirk R Kanter; James Jaggers; Jeffrey P Jacobs; Catherine Dent Krawczeski; Nancy Pike; Brian W McCrindle; Lisa Virzi; J William Gaynor Journal: N Engl J Med Date: 2010-05-27 Impact factor: 91.245
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Authors: Jeffrey A Feinstein; D Woodrow Benson; Anne M Dubin; Meryl S Cohen; Dawn M Maxey; William T Mahle; Elfriede Pahl; Juan Villafañe; Ami B Bhatt; Lynn F Peng; Beth Ann Johnson; Alison L Marsden; Curt J Daniels; Nancy A Rudd; Christopher A Caldarone; Kathleen A Mussatto; David L Morales; D Dunbar Ivy; J William Gaynor; James S Tweddell; Barbara J Deal; Anke K Furck; Geoffrey L Rosenthal; Richard G Ohye; Nancy S Ghanayem; John P Cheatham; Wayne Tworetzky; Gerard R Martin Journal: J Am Coll Cardiol Date: 2012-01-03 Impact factor: 24.094
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Authors: Anthony Azakie; Natalie C Johnson; Petros V Anagnostopoulos; Sami M Akram; Patrick McQuillen; Anil Sapru Journal: J Thorac Cardiovasc Surg Date: 2011-02 Impact factor: 5.209
Authors: Richard G Ohye; J William Gaynor; Nancy S Ghanayem; Caren S Goldberg; Peter C Laussen; Peter C Frommelt; Jane W Newburger; Gail D Pearson; Sarah Tabbutt; Gil Wernovsky; Lisa M Wruck; Andrew M Atz; Steve D Colan; James Jaggers; Brian W McCrindle; Ashwin Prakash; Michael D Puchalski; Lynn A Sleeper; Mario P Stylianou; Lynn Mahony Journal: J Thorac Cardiovasc Surg Date: 2008-05-19 Impact factor: 5.209