Abstract
BackgroundGiven our large catchment area that often results in later presentation age, we sought to understand our institutional outcomes for the Norwood operation in the context of published data. Specifically, we studied whether operative and late death post-Norwood are dependent on age at operation.MethodsRetrospective review of 105 consecutive infants undergoing Norwood (2004–2011) at our institution. Patients were divided into those undergoing Norwood ≤ 7 days of age (N = 43; 41%) and those undergoing Norwood > 7 days of age (N = 63; 59%). Operative mortality (≥30 days), interstage mortality (between Norwood and superior bidirectional Glenn), STS-mortality (operative death + in-hospital death), and late mortality, occurring any time following hospital discharge were compared among groups. Multivariable factors for mortality at each time-point were compared using logistic regression models.ResultsUnderlying diagnosis was HLHS in 67 (64%) with the remainder (N = 38; 36%) being other single ventricle variants. Median age at surgery was 8 days (range 1–63 days) and mean weight at surgery was 3.2 ± 0.6 kg. Pulmonary blood flow was provided by a right ventricle-pulmonary artery conduit in 94% (N = 99). Overall operative survival was 92%, with 73% (N = 66) undergoing bidirectional Glenn. Median age was higher for operative survivors compared to non-survivors (12 days vs. 5 days; P = 0.036), with operative mortality higher for infants ≤7 days at Norwood compared to infants >7 days at Norwood (14% vs. 3%; P = 0.04). After censoring for in-hospital death, age ≤ 7 days was also associated with increased risk for late death (26% vs. 5%; P = 0.005).ConclusionsIn contrast to other institutional series, infants at our center undergoing Norwood operation at an earlier age have worse outcomes. Adoption of published practice patterns could lead to different local outcomes because of intangible center-specific effects, underscoring the principle that results from one institution may not be generalizable to others. Targeted center-specific internal review, if possible, should precede externally recommended changes in practice.
Highlights
Given our large catchment area that often results in later presentation age, we sought to understand our institutional outcomes for the Norwood operation in the context of published data
Given our large catchment area that often results in later patient age at admission, we sought to understand our institutional outcomes in context of published data and determine whether operative and late death post-Norwood were dependent on age at operation
Preoperative creatinine was higher and there were a greater number of patients with hypoplastic left heart syndrome (HLHS) among those patients ≤ 7 days of age compared to the older neonates
Summary
Given our large catchment area that often results in later presentation age, we sought to understand our institutional outcomes for the Norwood operation in the context of published data. We studied whether operative and late death post-Norwood are dependent on age at operation. Several single-center studies have found that younger age at surgery leads to improved outcomes following Norwood operation [1,2,3,4,5,6,7]. Given our large catchment area that often results in later patient age at admission, we sought to understand our institutional outcomes in context of published data and determine whether operative and late death post-Norwood were dependent on age at operation
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