Norwood operation versus comprehensive stage II after bilateral pulmonary artery banding palliation for infants with critical left heart obstruction

Long-term outcomes of hypoplastic left heart syndrome with analysis of the Norwood procedure in infants following bilateral pulmonary artery banding

“… 1 The advantages of the staged Norwood procedure following BPAB include avoidance of cardiopulmonary bypass (CPB) in early neonates, which influences multiple immature organs; 2 stabilized hemodynamics; and allowance for body growth in patients with risk factors for the Norwood procedure, such as prematurity and low birth weight. 3 , 4 , 5 On the other hand, disadvantages of the staged Norwood procedure include potential bleeding due to surgical adhesion, prolonged CPB, decreased PA growth, and risks for inadequate cerebral and coronary flow maintained with prostaglandin E1 in patients with aortic atresia. 2 , 6 In contrast, the primary Norwood procedure offers certain advantages, including nonsurgical adhesion and potential PA growth with adjusted pulmonary blood flow; however, this procedure has been associated with high rates of low cardiac output syndrome and the need for extracorporeal membrane oxygenation (ECMO).…”