Evolving strategies and improving outcomes of the modified Norwood procedure: a 10- year single-institution experience Anthony Azakie, MD, Sandra L Merklinger,

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Presentation transcript:

Evolving strategies and improving outcomes of the modified Norwood procedure: a 10- year single-institution experience Anthony Azakie, MD, Sandra L Merklinger, MN, Brian W McCrindle, MD, Glen S Van Arsdell, MD, Kyong-Jin Lee, MD, Lee N Benson, MD, John G Coles, MD, William G Williams, MD The Annals of Thoracic Surgery Volume 72, Issue 4, Pages 1349-1353 (October 2001) DOI: 10.1016/S0003-4975(01)02795-3

Fig 1 Outcomes after modified Norwood procedure in 171 infants. Results of the staged reconstructive approach were as follows: the overall mortality rate after stage one was 41% with an interval attrition of an additional 15% of hospital survivors prior to stage-two reconstruction. The mortality rate for bidirectional cavopulmonary anastomosis (BDCPA) or hemi-Fontan operation was 2.5%, with an additional 2.5% mortality rate late after second-stage reconstruction. Hospital mortality after the Fontan procedure was 4%. Orthotopic heart transplantation (OHT) was performed in 1 child prior to and in 2 children after BDCPA for progressive ventricular dysfunction. The Annals of Thoracic Surgery 2001 72, 1349-1353DOI: (10.1016/S0003-4975(01)02795-3)

Fig 2 Kaplan-Meier survival curve for 171 children undergoing modified Norwood procedure. Numbers of patients at risk are shown above the horizontal axis. Survival is expressed as percentage with 95% confidence intervals (broken lines). The Annals of Thoracic Surgery 2001 72, 1349-1353DOI: (10.1016/S0003-4975(01)02795-3)

Fig 3 Overall Kaplan-Meier survival curves for the three consecutive patient cohorts. The difference in overall survival between eras was significant (p < 0.001). The Annals of Thoracic Surgery 2001 72, 1349-1353DOI: (10.1016/S0003-4975(01)02795-3)

Fig 4 Kaplan-Meier freedom from neoaortic obstruction is expressed as percentage with 95% confidence intervals (broken lines) and was 77% at 1 year. Numbers of patients at risk are shown above the horizontal axis. By multivariate regression analysis, the only independent predictor of neoaortic obstruction was smaller ascending aortic diameter at the time of the Norwood operation. The Annals of Thoracic Surgery 2001 72, 1349-1353DOI: (10.1016/S0003-4975(01)02795-3)