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BACKGROUND - Tremendous strides have been made in hospital survival for the Norwood procedure. Previous reports on risk factors for the Norwood have been on smaller groups of patients, or collected over relatively long periods of time, during which the care of these patients has greatly evolved. We hypothesized that with the improvements in management in the current era, many of the traditional risk factors for the Norwood procedure have been overcome.
METHODS - A single-institution review of all patients undergoing a Norwood from May 1, 2001-April 30, 2003 was performed. Patient demographics, anatomy, clinical condition, associated anomalies, operative details and outcome were recorded.
RESULTS - Of the 110 patients, there were 23 hospital deaths (21%). Univariate analysis revealed non-cardiac abnormalities (genetic abnormality or significant extra-cardiac malformation, p=0.0018), gestational age at operation (p=0.03), diagnosis of unbalanced atrioventricular septal defect (p=0.017) and weight <2.5 kg (p=0.0072) to be significantly related to hospital death. Obstructed pulmonary venous return, ascending aortic diameter, anatomic subtype, age, lowest pre-op pH, operative/bypass times, and antenatal diagnosis had no impact. On multivariate analysis, only weight <2.5 kg and non-cardiac abnormalities were found to be independent risk factors. Patients with either of these characteristics had a hospital survival of 52% (12/23), while those at standard risk had a survival of 87% (76/87).
CONCLUSIONS - Improvements in pre-operative, operative and post-operative management have overcome many of the previously reported risk factors related to variations in the cardiovascular anatomy. Non-cardiac abnormalities and low birth weight remain as a future challenge.