Modifications in surgical technique and protocol improve Norwood outcomes in a low volume institution
Background: Low volume institutions (<16 cases per year) may produce less favorable outcomes of the Staged Norwood procedure using Blalock Taussig shunt (BT) or right ventricle to pulmonary conduit (Sano).
Objectives: To compare Norwood BT/Sano outcomes after implementing a protocol in a single institution.
Methods: A retrospective review of all patients having staged Norwood BT/Sano reconstruction for **HLHS or its variants from 2002–2008. Modifications in the protocol included surgical techniques, post-operative care and follow-up surveillance.
Results: From 2002-2004, 48.3% had the Norwood/Sano procedure compared to 54.5% in 2005-2008 (p=0.600). Modified interventions resulted in improvements in 48-hr and 30-day mortality, and survival to Stage II Glenn procedure. Age at death between groups did not reach statistical significance (p=0.385).
Conclusions: Implementation of a multidisciplinary protocol improved survival to Stage II Glenn in patients undergoing the Norwood BT/Sano operation in a low volume institution.
| 2002 – 2004 Median (range) n=29 | 2005-2008 Median (range) n=44 | P value | ||
|---|---|---|---|---|
| Demographics | Age (days)/weight (Kg) at Norwood | 8(1-64)/3.3(2-4.4) | 9(3-55)/3.1(2-4.5) | 0.138/0.217 |
| Intervention | # of follow-up phone calls | 0.0 (0-9) | 6.0 (0-23) | *<0.001 |
| # of outpatient appointments | ƒ4.69 (6.11) | ƒ9.05 (5.62) | *0.003 | |
| # of readmissions | 1.0 (0-10) | 2.0 (0-6) | *0.010 | |
| Pre-stage II Glenn catheterization age (months) | 5.05 (2.2-10.8) | 5.3 (1.5-7.4) | 0.706 | |
| Age at stage II Glenn (months) | 6.5 (4.4-11.7) | 6.25 (4.2-8.7) | 0.886 | |
| Norwood BT/Sano outcomes | 48-hr/30-day Mortality (%) | 27.6/31.0 | 4.5/4.5 | *0.005/*0.002 |
| Survival to Stage II Glenn (%) | 39.0 | 83.0 | *<0.001 |