• Madison B Argo, David J Barron, Pirooz Eghtesady, Bahaaldin Alsoufi, Osami Honjo, Can Yerebakan, William M DeCampli, Jeffrey P Jacobs, Sergio A Carrillo, Anusha Jegatheeswaran, Tara Karamlou, Tharini Paramananthan, Maha Rahman, Linda M Lambert, Jennifer Nelson, Christopher A Caldarone, S Adil Husain, Mark E Galantowicz, Karthik Ramakrishnan, James K Kirklin, Joseph W Turek, Chelsea Mannie, Eugene H Blackstone, Michael E Mitchell, Brian W McCrindle, and Congenital Heart Surgeons' Society Critical Left Heart Obstruction Working Group.
• Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wis; Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada.
• J. Thorac. Cardiovasc. Surg. 2023 Sep 1; 166 (3): 943954.e1943-954.e1.

ObjectiveTo determine patient characteristics and outcomes after Norwood versus comprehensive stage II (COMPSII) for infants with critical left heart obstruction who had prior hybrid palliation (bilateral pulmonary artery banding ± ductal stent).MethodsFrom 23 Congenital Heart Surgeons' Society institutions (2005-2020), 138 infants underwent hybrid palliation followed by either Norwood (n = 73, 53%) or COMPSII (n = 65). Baseline characteristics were compared between Norwood and COMPSII groups. Parametric hazard model with competing risk methodology was used to determine risk and factors associated with outcomes of Fontan, transplantation, or death.ResultsInfants who underwent Norwood versus COMPSII had a higher prevalence of prematurity (26% vs 14%, P = .08), lower birth weight (median 2.8 vs 3.2 kg, P < .01) and less frequent ductal stenting (37% vs 99%; P < .01). Norwood was performed at a median age of 44 days and median weight of 3.5 kg, versus COMPSII at 162 days and 6.0 kg (both P < .01). Median follow-up was 6.5 years. At 5 years after Norwood and COMPSII, respectively; 50% versus 68% had Fontan (P = .16), 3% versus 5% had transplantation (P = .70), 40% versus 15% died (P = .10), and 7% versus 11% are alive without transition, respectively. For factors associated with either mortality or Fontan, only preoperative mechanical ventilation occurred more frequently in the Norwood group.ConclusionsHigher prevalence of prematurity, lower birth weight, and other patient-related characteristics in the Norwood versus COMPSII groups may influence differences in outcomes that were not statistically significant for this limited risk-adjusted cohort. The clinical decision regarding Norwood versus COMPSII after initial hybrid palliation remains challenging.Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

22 keywords...

hide…