Interdisciplinary cardiovascular and thoracic surgery · 2026
Outcomes of Delayed Norwood Operation in High-Risk Patients-Time to Reconsider the Dogma of a Primary Norwood Operation?
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ozturk Mahmut, Selcuk Arif, Tongut Aybala, Moynihan Elizabeth M, Desai Manan, Lopez Magallon Alejandro Jose, Donofrio Mary T, Gordish-Dressman Heather, Reid Kathleen Kalinger, Munoz Ricardo Alfonso, d'Udekem Yves, Wernovsky Gil, Yerebakan Can
Аннотация
OBJECTIVES: The delayed Norwood (DN) approach, preceded by bilateral pulmonary artery banding (bPAB), has emerged as a strategy to improve outcomes in high-risk infants by addressing neonatal haemodynamic instability and organ immaturity.
METHODS: This single-centre, retrospective study analysed 20 consecutive patients with hypoplastic left heart syndrome/variants and multiple risk factors who underwent a DN operation following bPAB between 2019 and 2024.
RESULTS: Bilateral pulmonary artery banding was performed at a median age of 2.5 days (interquartile range [IQR]: 2-4). Preoperative risk factors included prematurity (35%), low birth weight <2.5 kg (25%), non-cardiac comorbidities (25%), genetic syndromes (50%), preoperative cardiogenic shock (35%), and restrictive atrial septum (25%). The median age at DN was 36 days (IQR: 29-79), with an operative survival rate of 75%. Patients who underwent the DN within 4 weeks of bPAB did not require any pulmonary artery (PA) reinterventions. Median lactate clearance time was 8 hours (IQR: 5-18), and the median vasoactive inotropic score decreased by 47% within 48 hours postoperatively. Cerebral near-infrared spectroscopy values improved in patients without postoperative extracorporeal membrane oxygenation (ECMO) support from 53% to 58% and 63% at 0, 12, and 36 hours, respectively.
CONCLUSIONS: The DN approach, preceded by initial bPAB in a high-risk patient cohort, achieved surgical outcomes comparable to those of lower-risk patients undergoing primary Norwood operation. A DN procedure around 4-6 weeks of following bPAB may improve survival rates in high-risk patients with a reduction in surgical or catheter-based reinterventions.
METHODS: This single-centre, retrospective study analysed 20 consecutive patients with hypoplastic left heart syndrome/variants and multiple risk factors who underwent a DN operation following bPAB between 2019 and 2024.
RESULTS: Bilateral pulmonary artery banding was performed at a median age of 2.5 days (interquartile range [IQR]: 2-4). Preoperative risk factors included prematurity (35%), low birth weight <2.5 kg (25%), non-cardiac comorbidities (25%), genetic syndromes (50%), preoperative cardiogenic shock (35%), and restrictive atrial septum (25%). The median age at DN was 36 days (IQR: 29-79), with an operative survival rate of 75%. Patients who underwent the DN within 4 weeks of bPAB did not require any pulmonary artery (PA) reinterventions. Median lactate clearance time was 8 hours (IQR: 5-18), and the median vasoactive inotropic score decreased by 47% within 48 hours postoperatively. Cerebral near-infrared spectroscopy values improved in patients without postoperative extracorporeal membrane oxygenation (ECMO) support from 53% to 58% and 63% at 0, 12, and 36 hours, respectively.
CONCLUSIONS: The DN approach, preceded by initial bPAB in a high-risk patient cohort, achieved surgical outcomes comparable to those of lower-risk patients undergoing primary Norwood operation. A DN procedure around 4-6 weeks of following bPAB may improve survival rates in high-risk patients with a reduction in surgical or catheter-based reinterventions.