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J Thorac Cardiovasc Surg 2006;131:418-426
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Influence of surgical strategies on outcome after the Norwood procedure

^a Department of Pediatric Cardiac Surgery, Diana, Princess of Wales Children's Hospital, Birmingham, United Kingdom
^b Department of Pediatric Cardiology, Diana, Princess of Wales Children's Hospital, Birmingham, United Kingdom

Read at the Eighty-fifth Annual Meeting of The American Association for Thoracic Surgery, San Francisco, Calif, April 10-13, 2005.

Received for publication April 4, 2005; revisions received August 10, 2005; accepted for publication August 15, 2005.

^_* Address for reprints: William J. Brawn, FRCS, FRACS, Consultant Cardiac Surgeon, Department of Pediatric Cardiac Surgery, Diana, Princess of Wales Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom (Email: william.brawn{at}bch.nhs.uk).

OBJECTIVE: The study objective was to identify how the evolution of surgical strategies influenced the outcome after the Norwood procedure.

METHODS: From 1992 to 2004, 367 patients underwent the Norwood procedure (median age, 4 days). Three surgical strategies were identified on the basis of arch reconstruction and source of pulmonary blood flow. The arch was refashioned without extra material in group A (n = 148). The arch was reconstructed with a pulmonary artery homograft patch in groups B (n = 145) and C (n = 74). Pulmonary blood flow was supplied by a modified Blalock-Taussig shunt in groups A and B. Pulmonary blood flow was supplied by a right ventricle to pulmonary artery conduit in group C. Early mortality, actuarial survival, and freedom from arch reintervention or pulmonary artery patch augmentation were analyzed.

RESULTS: Early mortality was 28% (n = 102). Actuarial survival was 62% ± 3% at 6 months. Early mortality was lower in group C (15%) than group A (31%) or group B (31%; P <.05). Actuarial survival at 6 months was better in group C (78% ± 5%) than group A (59% ± 5%) or group B (58% ± 4%; P <.05). Fifty-three patients (14%) had arch reintervention. Freedom from arch reintervention was 76% ± 3% at 1 year, with univariable analysis showing no difference among groups A, B, and C (P =.71). One hundred patients (27%) required subsequent pulmonary artery patch augmentation. Freedom from patch augmentation was 61% ± 3% at 1 year, and was lower in group C (3% ± 3%) than group A (80% ± 4%) or group B (72% ± 5%; P <.05).

CONCLUSIONS: Survival after the Norwood procedure improved after the introduction of a right ventricle to pulmonary artery conduit, but a greater proportion of patients required subsequent pulmonary artery patch augmentation. The type of arch reconstruction did not affect the incidence of arch reintervention.

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