| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2004;77:477-483
© 2004 The Society of Thoracic Surgeons
a Department of Critical Care Medicine, Loma Linda University Children's Hospital, Loma Linda, California, USA
b Department of Cardiology, Loma Linda University Children's Hospital, Loma Linda, California, USA
d Department of Cardiothoracic Surgery, Departments of Pediatrics and Surgery, Loma Linda University Children's Hospital, Loma Linda, California, USA
c School of Allied Health Professionals, Loma Linda University, Loma Linda, California, USA
Accepted for publication August 6, 2003.
* Address reprint requests to Dr Checchia, Washington University School of Medicine, St. Louis Children's Hospital, Campus Box 8116, One Children's Place, Suite 5S20, St. Louis, MO 63110, USA
e-mail: checchia_p{at}kids.wustl.edu
BACKGROUND: We report the development and implementation of a program designed to assign patients preoperatively to either transplant or Norwood procedure based on a score derived from known risk factors and to enhance postoperative care of infants undergoing the Norwood procedure.
METHODS: A weighted score for each of six variables comprised the scoring system: ventricular function, tricuspid regurgitation, ascending aortic diameter, atrial septal defect blood flow characteristics, blood type, and age. The scoring system was used to prospectively assign mortality risk and lead to recommendation of either Norwood procedure or transplantation.
RESULTS: Survival following the Norwood procedure significantly improved after the management program was implemented (88% versus 40% at 48 hours, 57% versus 10% at 30 days, and 50% versus 10% at 1 year, p < 0.0001 at each time point). The survival of the group that received a score of 7 or less (high risk) who underwent the Norwood procedure was 78% at 48 hours, 44% at 30 days, and 33% at 1 year; survival rates among patients considered lower risk (greater than 7) were 100% at 48 hours and 80% at 30 days and 1 year. Transplant outcomes remained unchanged.
CONCLUSIONS: We report improved survival following the Norwood procedure after the implementation of an institutional management approach aimed at improving the outcome of infants with hypoplastic left heart syndrome and may help neutralize historical biases toward Norwood procedure or transplantation.
This article has been cited by other articles:
|
|
 |
|
  D. A. Hehir, T. E. Dominguez, J. A. Ballweg, C. Ravishankar, B. S. Marino, G. L. Bird, S. C. Nicolson, T. L. Spray, J. W. Gaynor, and S. Tabbutt Risk factors for interstage death after stage 1 reconstruction of hypoplastic left heart syndrome and variants J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 94 - 99. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Alsoufi, T. Karamlou, B. W. McCrindle, and C. A. Caldarone Management options in neonates and infants with critical left ventricular outflow tract obstruction Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1013 - 1021. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. S. Sundareswaran, K. R. Kanter, H. D. Kitajima, R. Krishnankutty, J. F. Sabatier, W. J. Parks, S. Sharma, A. P. Yoganathan, and M. Fogel Impaired power output and cardiac index with hypoplastic left heart syndrome: a magnetic resonance imaging study. Ann. Thorac. Surg., October 1, 2006; 82(4): 1267 - 1277. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Sinzobahamvya, J. Photiadis, D. Kumpikaite, C. Fink, H. C. Blaschczok, A. M. Brecher, and B. Asfour Comprehensive aristotle score: implications for the norwood procedure. Ann. Thorac. Surg., May 1, 2006; 81(5): 1794 - 1800. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. G. Berry, C. G. Cowley, C. J. Hoff, and R. Srivastava In-Hospital Mortality for Children With Hypoplastic Left Heart Syndrome After Stage I Surgical Palliation: Teaching Versus Nonteaching Hospitals Pediatrics, April 1, 2006; 117(4): 1307 - 1313. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Bacha, S. Daves, J. Hardin, R.-i. Abdulla, J. Anderson, M. Kahana, P. Koenig, B. N. Mora, M. Gulecyuz, J. P. Starr, et al. Single-ventricle palliation for high-risk neonates: The emergence of an alternative hybrid stage I strategy J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 163 - 171. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Tabbutt, T. E. Dominguez, C. Ravishankar, B. S. Marino, P. J. Gruber, G. Wernovsky, J. W. Gaynor, S. C. Nicolson, and T. L. Spray Outcomes After the Stage I Reconstruction Comparing the Right Ventricular to Pulmonary Artery Conduit With the Modified Blalock Taussig Shunt Ann. Thorac. Surg., November 1, 2005; 80(5): 1582 - 1591. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Checchia, J. McCollegan, N. Daher, N. Kolovos, F. Levy, and B. Markovitz The effect of surgical case volume on outcome after the Norwood procedure J. Thorac. Cardiovasc. Surg., April 1, 2005; 129(4): 754 - 759. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Rellensmann, T. Krasemann, and H.-G. Kehl Should All Stage-One Norwood Patients Receive a Prolonged Period of Postoperative Mechanical Circulatory Support? Ann. Thorac. Surg., March 1, 2005; 79(3): 1098 - 1099. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
