Modified Norwood procedure with a high-flow cardiopulmonary bypass strategy results in low mortality without late arch obstruction

Poirier, Nancy; Drummond-Webb, Jonathan J.; Hisamochi, Kunikazu; Imamura, Michiaki; Harrison, A. Marc; Mee, Roger B.B.

doi:10.1067/mtc.2000.109540

Cited by 109 publications

(54 citation statements)

References 12 publications

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“…Despite the favorable outcomes currently achieved with the first-stage mBT procedure, a 4% to 15% late death risk still persists before the second palliation stage 11,[27][28][29] , although the use of a home surveillance program could reduce this risk 30 . The use of a RV-PA conduit reduced interstage mortality among Norwood procedure survivors in a study published by Pizarro, in which 40 out of 46 Blalock-Taussig group patients and 49 out of 50 RV-PA conduit group patients achieved the hemi-Fontan stage with interim mortality rates of 13% and 2%, respectively 31 .…”

Section: Discussionmentioning

confidence: 99%

Síndrome da hipoplasia do coração esquerdo: a influência da estratégia cirúrgica nos resultados

Silva¹,

Fonseca²,

Baumgratz³

et al. 2007

Arq. Bras. Cardiol.

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SummaryObjectives: To report a surgical strategy for the Norwood procedure in the hypoplastic left heart syndrome (HLHS) that enables short hypothermic circulatory arrest time and aortic arch reconstruction with autologous pericardium patch, and to compare the results of the modified Blalock- Taussig Results: In-hospital survival for the entire cohort was 74.64%, or 67.57% and 82.35% for the mBT shunt and RV-PA conduit groups, respectively (p=0.1808). Mortality rates between the first and second palliation stages were 40% and 4.4% for the mBT shunt and RV-PA conduit groups, respectively (p=0.0054). Hypothermic circulatory arrest times were 45.79±1.99 min and 36.62±1.62min (p=0.0012), respectively. Late coarctation of the aorta occurred in five patients (7.2%).Conclusions: This surgical strategy resulted in short circulatory arrest time, low mortality and favorable morphology of the neoaorta, with low incidence of late coarctation of the aorta. The higher rate of survival to first palliation stage with the RV-PA conduit was not significant, but interstage mortality was statistically lower when compared with the modified Blalock-Taussig shunt procedure.

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Section: Discussionmentioning

confidence: 99%

Síndrome da hipoplasia do coração esquerdo: a influência da estratégia cirúrgica nos resultados

Silva¹,

Fonseca²,

Baumgratz³

et al. 2007

Arq. Bras. Cardiol.

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“…Poirier et al [22] modified the reconstruction of the neoaorta and proposed high-flow CPB using phenoxybenzamine to reduce systemic vascular resistance. Another change that resulted in higher stability of the patient in the postoperative period was the anastomosis of the PTFE tube between the right ventricle and the pulmonary arteries or Sano's operation [23].…”

Section: Discussionmentioning

confidence: 99%

Nova técnica: operação de Norwood com perfusão regional cerebral e coronariana

Furlanetto¹,

Furlanetto²,

Henriques³

et al. 2009

Rev Bras Cir Cardiovasc

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Objective: To assess the immediate result of the modified Norwood procedure with new technique of anterograde regional cerebral perfusion (rACP) and retrograde regional coronary perfusion (rRCorP) in substitution of profound hypothermia and circulatory arrest in children with hypoplastic left heart syndrome (HLHS) with extremely hypoplastic ascending aorta (HA).Methods: In the period of December of 2006 to February 2008 the modified Norwood procedure with tube between the right ventricle and pulmonary arteries or Sano shunt was performed in eight children with HLHS and with ascending aorta diameter less than 3 mm, (four male and four female) with median age of 9.2 days (ranging from 1 to 29 days) and median weigh of 3.3 kg (ranging from 2.7 to 3.8 kg). We used cardiopulmonary bypass and hypothermia at 25°C with two venous cannulas and suture with a polytetrafluoroethylene graft sutured to the innominate artery as an arterial line and used to ARCeP. The RRCoP was performed by a deviation in the arterial line and placement of a catheter in the ascending aorta. The immediate surgical results and the clinical neurological manifestation were assessed. Results: The immediate surgical results revealed mortality of 25% and there were absence of neurological injury at clinical examination. Conclusions:The modified Norwood procedure can be accomplished with ARCeP and RRCoP in children with HLHS with HA with satisfactory immediate surgical result and without neurological complications.Descriptors: Hypoplastic left heart syndrome. Heart defects, congenital/surgery. Cardiac surgical procedures. Extracorporeal circulation/methods.

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“…16 More recently the use of alpha blockade has been introduced with remarkable improvement in survival after the Norwood operation. [7][8][9] The alpha blockade strategy centers on the decrease of the energy requirement and oxygen consumption from the injured postoperative neonatal myocardium. It is well-established that the energy expenditure is greater when the heart is faced with increase afterload than when it is ejecting a larger volume of blood against a lower pressure.…”

Section: Discussionmentioning

confidence: 99%

“…The principle of this approach is the increase in systemic cardiac output by maximal dilatation of the systemic circulation. [7][8][9] This effect results in a more stable parallel circulation through prevention of fluctuations in systemic vascular resistance in the early postoperative period. 9 We have incorporated this approach in our postoperative management protocol 10 and have observed a decrease in sudden cardiac collapse.…”

mentioning

confidence: 99%

Prevention of Early Sudden Circulatory Collapse After the Norwood Operation

et al. 2004

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Background-After modifications in our perioperative management protocol, we have observed a decrease in sudden circulatory collapse after the Norwood operation. The current study examines early outcomes after the Norwood operation in our unit in an attempt to identify variables that may have altered the risk of unexpected circulatory collapse. Methods and Results-We studied 105 consecutive neonates who underwent a Norwood operation in our institution. Our treatment protocol has changed in the past 3 years to include the use of alpha-blockade with phenoxybenzamine (POB) for systemic afterload reduction and selective cerebral perfusion. Forty-eight infants had selective cerebral perfusion. Forty-two infants received POB. Sixty patients had hypoplastic left heart syndrome.

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Modified Norwood procedure with a high-flow cardiopulmonary bypass strategy results in low mortality without late arch obstruction

Cited by 109 publications

References 12 publications

Síndrome da hipoplasia do coração esquerdo: a influência da estratégia cirúrgica nos resultados

Síndrome da hipoplasia do coração esquerdo: a influência da estratégia cirúrgica nos resultados

Nova técnica: operação de Norwood com perfusão regional cerebral e coronariana

Prevention of Early Sudden Circulatory Collapse After the Norwood Operation

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