Outcomes of hybrid and Norwood Stage I procedures for the treatment of hypoplastic left heart syndrome and its variants

Erek, Ersin; Aydın, Selim; Temur, Bahar; Önalan, Mehmet Akif; Suzan, Dilek; İyigün, Müzeyyen; Demir, İbrahim; Ödemiş, Ender

doi:10.5606/tgkdc.dergisi.2020.18605

Cited by 8 publications

(9 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hypoplastic left heart surgery is a relatively new practice in Turkey and the results are improving with the increasing experience. 10 The relation between age and surgical mortality is well known and documented in almost all publications. Mortality and morbidity were higher in neonatal age group as expected, following infants.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

First Harvest of Pediatric and Congenital Heart Surgery Multicenter Database in Turkey: Novel Application of Real-Time Online Reporting

Erek¹,

Yalçınbaş²,

Sariosmanoğlu

et al. 2021

World J Pediatr Congenit Heart Surg

Self Cite

View full text Add to dashboard Cite

Objectives: A new congenital heart surgery database (CKCV) with real-time online reporting function was recently developed in Turkey. All standard international parameters were used, but Aristotle Comprehensive Complexity score was modified. In this study, the first analysis of the CKCV Database is reported. Methods: The CKCV Database included 2307 procedures from 12 centers between January 2018 and March 2020. All parameters, including 10 real-time online reports, which represent the number of centers, number and mortality rates of all procedures, number of extracorporeal membrane oxygenation (ECMO) and results, details of postoperative complications, age-group statistics, analysis for priority status, mean intensive care and hospital stay durations of the procedures, results of Aristotle Basic, Modified Aristotle Comprehensive (MACC) and Society of Thoracic Surgeons-European Association (STAT) Score Categories, comparison of centers were analyzed. Results: Most common 10 procedures were ventricular septal defect (VSD) repair (n = 273), tetralogy of Fallot (TOF) repair (n = 243), atrial septal defect (ASD) repair (n = 181), complete AVSD repair (n = 95), cavopulmonary anastomosis (n = 81), systemic to pulmonary shunt (n = 79), modified Fontan (n = 71), subaortic resection, (n = 66) PA banding (n = 66), and arterial switch operation (n = 66). Cardiopulmonary bypass was used in 84.6% of the procedures. Overall mortality rate was 6.0%. A total of 618 major and 570 minor complications were observed in 333 and 412 patients, respectively. According to six MACC categories, number of the patients and mortality rates were I (293; 0.3%); II (713; 1.4%); III (601; 3.3%); IV (607; 12%); V (84; 35.7%); and VI (9; 55.6%), respectively. Analysis of five STAT Categories showed 0.7, 3.8, 5.4, 14.9, and 54.7% mortality rates. Conclusions: CKCV Database has a great potential for nationwide quality improvement studies. Users could instantly analyze and compare their results to national and international aggregate data using a real-time online reporting function. This is the first multicenter congenital database study in Turkey.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Hypoplastic left heart surgery is a relatively new practice in Turkey and the results are improving with the increasing experience. 10…”

Section: Discussionmentioning

confidence: 99%

First Harvest of Pediatric and Congenital Heart Surgery Multicenter Database in Turkey: Novel Application of Real-Time Online Reporting

Erek¹,

Yalçınbaş²,

Sariosmanoğlu

et al. 2021

World J Pediatr Congenit Heart Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“…[ 8 ] As we understand from our early experience and the reports from other institutes, the mortality and morbidity rates of clinics can be quite high, when they are in the learning curve for Norwood surgery[ 9 , 10 ] and it can be speculated that Norwood surgery is still in the development phase in our country. [ 11 - 13 ] However, early mortality after Norwood surgery still stands out as the most important problem that needs to be tackled.…”

Section: Discussionmentioning

confidence: 99%

“…[ 14 ] However short- and long-term outcomes of hybrid procedures have shown great variability including some very unfavorable results. [ 15 ] In Turkey, Erek et al[ 11 ] reported the comparison of surgical and hybrid Norwood procedures and showed that the hybrid approach did not have promising results. Discouraging results were obtained in our attempts as well, five of six patients died in the early period and one died in the inter-stage period.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Norwood procedure with hypoplastic left heart syndrome: Our 12-year single-center experience

Özdemir¹,

Korun²,

Dedemoğlu³

et al. 2022

Turk Gogus Kalp Dama

View full text Add to dashboard Cite

Background: In this study, we aimed to analyze the predictors and risk factors of mortality in patients who underwent Norwood I procedure with the diagnosis of hypoplastic left heart syndrome. Methods: Between January 2009 and December 2020, a total of 139 patients (95 males, 44 females) who underwent Norwood I procedure with the diagnosis of hypoplastic left heart syndrome in our center were retrospectively analyzed. Results: The median birth weight was 3,200 (range, 3,000 to 3,350) g and the median age at the time of operation was seven (range, 5 to 10) days. Pulmonary flow was achieved with a Sano shunt in the majority (72%) of patients. Survival rate was 41% after the first stage. Reoperation for bleeding (p=0.017), reoperation for residual lesion (p=0.011), and postoperative peak lactate level (p=0.029), were associated with in-hospital mortality. Nineteen (33%) of 57 patients died before the second stage. Thirty-three (58%) patients underwent second stage, and survival after the second stage was 94%. Thirteen patients underwent third stage, and survival after the third stage was 85%. Estimated probability of survival at six months, and one, two, three, and four years were 33%, 33%, 25%, 25%, and 22% respectively. Conclusion: Hospital and inter-stage mortality rates are still high and this seems to be the most challenging period in term of survival efforts of the patients with hypoplastic left heart syndrome. Early recognition and reintervention of anatomical residual defects, close follow-up in the inter-stage period, and the accumulation of multidisciplinary experience may help to improve the results to acceptable limits.

show abstract

“…It is used as a standard of care in some centers, and others use this approach in lieu of the Norwood procedure for particular indications, like severe LV outflow tract obstruction or in low-birth-weight neonates. 41,42 This technique consists of placing a band around each pulmonary artery to limit flow to the pulmonary vasculature. Additionally, a metal stent is placed on the ductus arteriosus, to maintain its patency and allow for systemic perfusion.…”

Section: Surgical Managementmentioning

confidence: 99%

Hypoplastic Left Heart Syndrome: A Review

Ramonfaur

Zhang

Garza

et al. 2022

Cardiology in Review

View full text Add to dashboard Cite

Hypoplastic left heart syndrome is a rare and poorly understood congenital disorder featuring a univentricular myocardium, invariably resulting in early childhood death if left untreated. The process to palliate this congenital cardiomyopathy is of high complexity and may include invasive interventions in the first week of life. The preferred treatment strategy involves a staged correction with 3 surgical procedures at different points in time. The Norwood procedure is usually performed within the first weeks of life and aims to increase systemic circulation and relieve pulmonary vascular pressure. This procedure is followed by the bidirectional Glenn and the Fontan procedures in later life, which offer to decrease stress in the ventricular chamber. The prognosis of children with this disease has greatly improved in the past decades; however, it is still largely driven by multiple modifiable and nonmodifiable variables. Novel and clever alternatives have been proposed to improve the survival and neurodevelopment of these patients, although they are not used as standard of care in all centers. The neurodevelopmental outcomes among these patients have received particular attention in the last decade in light to improve this very limiting associated comorbidity that compromises quality of life.

show abstract

Outcomes of hybrid and Norwood Stage I procedures for the treatment of hypoplastic left heart syndrome and its variants

Cited by 8 publications

References 26 publications

First Harvest of Pediatric and Congenital Heart Surgery Multicenter Database in Turkey: Novel Application of Real-Time Online Reporting

First Harvest of Pediatric and Congenital Heart Surgery Multicenter Database in Turkey: Novel Application of Real-Time Online Reporting

Outcomes of Norwood procedure with hypoplastic left heart syndrome: Our 12-year single-center experience

Hypoplastic Left Heart Syndrome: A Review

Contact Info

Product

Resources

About