Normothermic Versus Hypothermic Norwood Procedure.

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• The Norwood procedure is a critical intervention for hypoplastic left heart syndrome (HLHS).
• Current standard practice involves deep hypothermia with circulatory arrest or hypothermic perfusion with antegrade selective cerebral perfusion (ASCP).
• Normothermic perfusion has been explored in pediatric cardiac surgery.

Purpose of the Study:

• To compare early outcomes of the Norwood procedure using ASCP under normothermia versus hypothermia.
• To evaluate the feasibility and safety of normothermic perfusion in HLHS repair.

Main Methods:

• A retrospective review of 117 consecutive HLHS patients undergoing the Norwood procedure with ASCP from 2005 to 2020.
• Patients were divided into two groups: hypothermic (n=68) and normothermic (n=49).
• ASCP flow was maintained to ensure right radial arterial pressure >50 mmHg (40-50 mL/kg/min).

Main Results:

• Both groups had similar baseline characteristics and cardiovascular diagnoses.
• The normothermic group demonstrated significantly shorter bypass (90.3 vs 123.6 min), cross-clamp (45.2 vs 81.9 min), and ASCP times (25.6 vs 47.3 min) (P < .001).
• No significant differences were observed in immediate postoperative course or in-hospital mortality (18.4% normothermic vs 14.9% hypothermic; P = .81).

Conclusions:

• The normothermic Norwood procedure with ASCP is feasible and safe.
• Short-term outcomes and in-hospital mortality are comparable to the standard hypothermic approach.
• Normothermia presents a viable alternative for HLHS repair.