Influence of surgical strategies on outcome after the Norwood procedure

ObjectiveThe study objective was to identify how the evolution of surgical strategies influenced the outcome after the Norwood procedure.MethodsFrom 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.ResultsEarly 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).ConclusionsSurvival 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.