ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Outcomes of Norwood procedure with hypoplastic left heart syndrome: Our 12-year single-center experience
Fatih Özdemir1, Oktay Korun1, Mehmet Dedemoğlu2, Murat Çiçek1, Mehmet Biçer3, Okan Yurdakök1, Hüsnü Fırat Altın1, Emine Hekim Yılmaz4, Nurgül Yurtseven5, Numan Ali Aydemir1, Ahmet Şaşmazel1
1Department of Pediatric Cardiovascular Surgery, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
2Department of Pediatric Cardiovascular Surgery, University of Health Sciences Ümraniye Training and Research Hospital, Istanbul, Turkey
3Department of Pediatric Cardiovascular Surgery, Koç University Hospital, Istanbul, Turkey
4Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
5Department of Anesthesiology and Reanimation, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
DOI : 10.5606/tgkdc.dergisi.2022.22397
Background: In this study, we aimed to analyze the predictors and risk factors of mortality in patients who underwent Norwood I procedure with the diagnosis of hypoplastic left heart syndrome.

Methods: Between January 2009 and December 2020, a total of 139 patients (95 males, 44 females) who underwent Norwood I procedure with the diagnosis of hypoplastic left heart syndrome in our center were retrospectively analyzed.

Results: The median birth weight was 3,200 (range, 3,000 to 3,350) g and the median age at the time of operation was seven (range, 5 to 10) days. Pulmonary flow was achieved with a Sano shunt in the majority (72%) of patients. Survival rate was 41% after the first stage. Reoperation for bleeding (p=0.017), reoperation for residual lesion (p=0.011), and postoperative peak lactate level (p=0.029), were associated with in-hospital mortality. Nineteen (33%) of 57 patients died before the second stage. Thirty-three (58%) patients underwent second stage, and survival after the second stage was 94%. Thirteen patients underwent third stage, and survival after the third stage was 85%. Estimated probability of survival at six months, and one, two, three, and four years were 33%, 33%, 25%, 25%, and 22% respectively.

Conclusion: Hospital and inter-stage mortality rates are still high and this seems to be the most challenging period in term of survival efforts of the patients with hypoplastic left heart syndrome. Early recognition and reintervention of anatomical residual defects, close follow-up in the inter-stage period, and the accumulation of multidisciplinary experience may help to improve the results to acceptable limits.

Keywords : Hypoplastic left heart syndrome, inter-stage mortality, Norwood procedure
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