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Long-term outcomes of hypoplastic left heart syndrome with analysis of the Norwood procedure in infants following bilateral pulmonary artery banding.
- Source :
-
JTCVS open [JTCVS Open] 2023 Aug 14; Vol. 16, pp. 675-688. Date of Electronic Publication: 2023 Aug 14 (Print Publication: 2023). - Publication Year :
- 2023
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Abstract
- Objective: To investigate the early and long-term outcomes of the deferred Norwood procedure by bilateral pulmonary artery banding (BPAB) versus the neonatal Norwood procedure.<br />Methods: This retrospective study examined 46 patients with hypoplastic left heart syndrome and its variants undergoing the Norwood procedure for single ventricle physiology between 2004 and 2022 at 3 institutions. The patients were divided into 2 groups: neonatal Norwood procedure (group N; n = 23) and staged Norwood procedure in infants following BPAB (group I; n = 23). Preoperative risk factors, surgical results, survival rates, Fontan candidacy, and long-term complications were compared.<br />Results: Early survival rates after the Norwood procedure were 91.3% (21 of 23) in both groups. Late survival rates after the Norwood procedure were similar at the 10-year follow-up (group N, 76.3%; group I, 68.7%; P  = .63). Fontan completion rates also were comparable in the 2 groups (group N, 77.8%; group I, 85.7%; P  = .67). Group N showed a higher median pulmonary artery (PA) index before bidirectional cavopulmonary connection (group N, 177 [interquartile range (IQR), 147-243] mm <superscript>2</superscript> /m <superscript>2</superscript> ; group I, 152 [IQR, 146-163] mm <superscript>2</superscript> /m <superscript>2</superscript> ; P  = .03); this trend continued until 5 years after Fontan completion ( P  = .01). Group N also had a lower rate of freedom from protein-losing enteropathy (PLE) at 9.0 years after the Fontan operation (90.0% vs 52.5% for group I; P  = .04), although the incidences of other Fontan-associated events were not significantly different.<br />Conclusions: Fontan candidacy and survival rates were similar regardless of the timing of the Norwood procedure. Early performance of the Norwood procedure may lead to lower rates of late Fontan-associated events, such as PLE.<br /> (© 2023 The Author(s).)
Details
- Language :
- English
- ISSN :
- 2666-2736
- Volume :
- 16
- Database :
- MEDLINE
- Journal :
- JTCVS open
- Publication Type :
- Academic Journal
- Accession number :
- 38204621
- Full Text :
- https://doi.org/10.1016/j.xjon.2023.07.023