Abstract 16411: Intraoperative Nicardipine Use During Rewarming in Norwood Procedures

Abstract

Introduction: Postoperative tissue edema Norwood procedures contributes significantly to outcomes. As nicardipine preserves ventricular function after hypothermic ischemic arrest, nicardipine treatment could support post-Norwood ventricular function, and decrease edema to improve patient outcomes. Methods: All Norwood procedures completed at a single institute between 1/1/2012 - 12/31/2019 were retrospectively reviewed, and the use of nicardipine during rewarming was initiated midway through the study period. We investigated the effects of nicardipine during rewarming on 12-month postoperative mortality, postoperative intubation times, open chest duration, and disposition at discharge. Results: Thirty-six Norwood procedures were completed, of whom 14 received nicardipine intraoperatively during the rewarming period. The nicardipine group demonstrated significantly lower 12-month postoperative mortality (0% vs 32%, p-value: 0.028) and significantly greater discharges to home (64% vs 18%, p-value: 0.005). The nicardipine group had lower median length of postoperative intubation (123 vs 146 hrs, p-value: 0.311) and open sternum time (2 [1-3] vs 3 [2-5] days, p-value: 0.067), but these analyses did not reach statistical significance (Fig 1). Conclusion: This study demonstrates the safety of nicardipine treatment during Norwood and significant decrease 12-month mortality and increase in discharge to home, with potential for reduced post-Norwood intubation and open sternum times. This study provides the basis for a prospective randomized controlled trial to demonstrate survival benefit provided by intraoperative nicardipine usage during Norwoods.