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Updated: May 24, 2026
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Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Does the shunt type determine mid-term outcome after Norwood operation?
Joachim Photiadis1, Nicodème Sinzobahamvya, Christoph Haun
1Department of Paediatric Cardio-Thoracic Surgery, German Paediatric Heart Centre, Deutsches Kinderherzzentrum, Asklepios Clinic, Sankt Augustin, Germany. photiadis@gmx.de
Summary
Preoperative risk factors, not shunt type, significantly impact midterm survival after the Norwood procedure. High-risk patients face higher mortality, while Sano shunt use increases intervention needs.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
- Surgical Outcomes Research
Background:
- The Sano (right ventricular to pulmonary artery) shunt is increasingly preferred for the Norwood procedure, but comprehensive risk analysis and long-term outcomes are lacking.
- Previous studies often compared consecutive cohorts, limiting direct comparison of shunt types within the same time frame.
- The impact of preoperative risk stratification on outcomes beyond the first year post-Norwood procedure requires further investigation.
Purpose of the Study:
- To compare midterm outcomes of the Sano shunt versus the modified Blalock-Taussig (BT) shunt in neonates undergoing the Norwood procedure.
- To evaluate the influence of preoperative risk factors, assessed by the Aristotle Comprehensive Score (ACS), on survival.
- To identify risk factors associated with midterm mortality after the Norwood procedure.
Main Methods:
- A retrospective review of 109 neonates who underwent the Norwood procedure between 2002 and 2009.
- Patients received either a Sano shunt (n=38) or a BT shunt (n=71) based on surgeon preference.
- Preoperative risk was stratified using the Aristotle Comprehensive Score (ACS), with high-risk defined as ACS ≥ 20.
Main Results:
- Actuarial survival was similar for both Sano and BT shunts (approximately 78.6%) at a mean follow-up of 4.1 years.
- Midterm survival was significantly higher in low-risk patients (88.2%) compared to high-risk patients (61.5%).
- Risk factors for mortality included cardiorespiratory failure and high ACS (≥ 20), but not shunt type. Sano shunts required more interventions before the Glenn procedure.
Conclusions:
- Preoperative risk factors, particularly a high ACS, are the primary determinants of midterm survival after the Norwood procedure, irrespective of shunt type.
- While the Sano shunt may be necessary in select cases, its increased need for interventions warrants reconsideration of its widespread use.
- Low-risk patients achieve excellent outcomes, but high-risk cases continue to experience significant mortality, highlighting the need for improved risk stratification and management strategies.
