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Risk factors for interstage death after the Norwood procedure.

J M Simsic1, S M Bradley, M R Stroud

  • 1Division of Pediatric Cardiology, Medical University of South Carolina, 171 Ashley Ave., Charleston, SC 29425, USA. simsicj@kidsheart.com

Pediatric Cardiology
|December 24, 2005
PubMed
Summary

Interstage mortality remains a concern for Norwood procedure survivors. Postoperative arrhythmias and decreased ventricular function increase the risk of death before the second stage of palliation.

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Area of Science:

  • Pediatric Cardiac Surgery
  • Congenital Heart Disease Management

Background:

  • The Norwood procedure is a critical first step for complex single-ventricle congenital heart defects.
  • While operative survival has improved, significant mortality occurs between the Norwood procedure and the planned second-stage palliation (interstage period).

Purpose of the Study:

  • To identify risk factors associated with mortality in infants who survive the initial Norwood procedure but have not yet reached the second stage of surgical palliation.

Main Methods:

  • Retrospective review of 50 patients who underwent the Norwood procedure between January 1996 and January 2001.
  • Analysis of patient and procedural variables to determine risk factors for interstage mortality.

Main Results:

  • Eight out of 50 (16%) Norwood survivors died during the interstage period.

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  • Multivariate analysis identified postoperative arrhythmias (p = 0.02) and diminished ventricular function at hospital discharge (p = 0.05) as significant risk factors for interstage mortality.

    • Conclusions:

    • A substantial risk of interstage mortality persists for Norwood procedure survivors.
    • Infants experiencing postoperative arrhythmias or exhibiting decreased ventricular function at discharge require closer monitoring and potentially more aggressive medical management to mitigate the risk of interstage death.