Functional improvement of heart failure in infants and children following the neonatal Norwood procedure.

OBJECTIVES

Heart failure induced by systemic ventricular dysfunction after the Norwood procedure may improve with medications. This study aimed to evaluate the incidence of heart failure, medication use, and subsequent improvement after the Norwood procedure.

METHODS

Among the patients undergoing the Norwood procedure between 2001 and 2024, those who demonstrated heart failure (systemic ventricular dysfunction lasting > 30 days) were identified. Medical therapy and clinical outcomes were evaluated in relation to the recovery of systemic ventricular dysfunction.

RESULTS

Among 380 patients after the Norwood procedure, heart failure was observed in 55 patients. Recovery of systemic ventricular function occurred in 21 patients with a median duration of 187 (interquartile range: 77-354) days. The cumulative incidence of recovery was 60.9% at 5 years. Recovery was more frequently observed in patients whose onset was between stage II and III palliation than in other periods (58% vs. 28%, p = .029). Survival after the onset of heart failure was better in patients who showed recovery than in those who did not (88.8% vs. 26.7% at 5 years, p < .001). At the onset of heart failure, zlog-N-terminal prohormone of brain natriuretic peptide (4.2 ± 1.3 vs. 4.5 ± 1.3, p = .55) was similar but differed at the last follow-up (2.2 ± 1.3 vs. 5.1 ± 1.5, p = .01) in patients with and without recovery. A phosphodiesterase type 5 inhibitor was identified as a factor that promoted the recovery (hazard ratio: 5.89, p < .01).

CONCLUSIONS

In patients who developed heart failure after the Norwood procedure, survival was better in those with recovered function than in those with sustained dysfunction. Phosphodiesterase type 5 inhibitors were identified as a factor promoting the recovery.