MORE THAN 10 YEARS SINGLE CENTRE EXPERIENCE WITH NORWOOD STAGE I PROCEDURE

Abstract

The aim of our study is to report the results of 10 years, single centre experience, in the treatment of hypoplastic left heart syndrome. Methods: Between 2007 and 2017, 80 consecutive patients underwent Norwood Stage 1 procedure at our Institution. Sixty-six patients had HLHS, 5 had unbalanced AV Canal and 11 other single ventricle lesion with ductal dependent circulation and/or multilevel systemic obstruction. Twenty patients were staged by a previous bilateral pulmonary banding. All patients received patch reconstruction of aortic arch while pulmonary blood flow was accomplished by a BTS in 37 pts, RVPA conduit in 41 and a BCPA in 2. Results: Overall hospital survival was 74,5 %, increasing after 2012 (63% vs 85%): only one patient died in the last 30 consecutive patients. One year transplant free survival was 72%. At univariate analysis, age at operation, weight less than 2,5 kg, prenatal diagnosis, presence of aortic atresia, systemic AV valve regurgitation, obstruction in pulmonary veins and use of BTS instead of RVPA conduit were not associated with increase in-hospital mortality. Only the year of operation (after 2012) was associated with better survival. During the follow-up, 55 patients underwent BCPA as a second stage, 17 patients underwent Fontan completions and two patients had heart transplant. Conclusions: Beside limitation due to patient number that did not allow identification of mortality predictors our data suggest that in centres with strong commitment to Norwood procedure, hospital survival is improving continuously and is actually comparable to other complex biventricular lesions.