Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt Shunji Sano, MD, Shu-Chien Huang, MD, Shingo Kasahara,

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Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt Shunji Sano, MD, Shu-Chien Huang, MD, Shingo Kasahara, MD, Ko Yoshizumi, MD, Yasuhiro Kotani, MD, Kozo Ishino, MD The Annals of Thoracic Surgery Volume 87, Issue 1, Pages 178-186 (January 2009) DOI: 10.1016/j.athoracsur.2008.08.027 Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Surgical techniques of modified Norwood stage 1 operation are illustrated. (Left) Initially, the arterial cannula was inserted into a 3.5-mm tube that was anastomosed to the innominate artery. (Middle) Under selective cerebral perfusion through the innominate artery, the aortic arch was opened inferiorly; and this incision was extended down into the ascending aorta to the level of the transected end of the main pulmonary artery. Aortic arch and ascending aorta just opposite the site of the innominate artery were sutured inferiorly to extend the width of the aortic arch and shorten the neoaortic suture line (proximal arch plasty). This modification shifted the proximal aortic arch inferiorly. The cuff and shunt were anastomosed to the distal end of the main pulmonary artery during cooling. (Right) The distal neoaortic reconstruction was completed by direct anastomosis in most cases. The Annals of Thoracic Surgery 2009 87, 178-186DOI: (10.1016/j.athoracsur.2008.08.027) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Summary of outcomes for all patients. (BDG = bidirectional Glenn shunt; BVR = biventricular repair; HD = hospital death; LD = late death; RV-PA = right ventricle to pulmonary artery; S1P = Norwood stage 1 palliation.) The Annals of Thoracic Surgery 2009 87, 178-186DOI: (10.1016/j.athoracsur.2008.08.027) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The Kaplan-Meier survival curve of the whole cohort. The estimated 1-year survival rate and the 5-year survival rate were 80% and 73%, respectively. The Annals of Thoracic Surgery 2009 87, 178-186DOI: (10.1016/j.athoracsur.2008.08.027) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 The Kaplan-Meier survival curve of the classical hypoplastic left heart syndrome (solid line) versus the variants (dotted line). The patients with classical hypoplastic left heart syndrome had a tendency toward lower survival, but that not reach statistical significance (p = 0.06). The number of patients at risk for 0, 1, 3, and 5 years is shown. The Annals of Thoracic Surgery 2009 87, 178-186DOI: (10.1016/j.athoracsur.2008.08.027) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 (A) Body weight (BW) less than 2.5 kg (dotted line) and (B) tricuspid regurgitation (TR) of 2+ or more (dotted line) were two independent factors associated with a significantly shorter duration of survival by Cox regression analysis. The number of patients at risk for 0, 1, 3, and 5 years is shown. (Body weight 2.5 kg or more = solid line; tricuspid regurgitation less than 2+ = solid line.) The Annals of Thoracic Surgery 2009 87, 178-186DOI: (10.1016/j.athoracsur.2008.08.027) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions