Original article: cardiovascularEvolving strategies and improving outcomes of the modified Norwood procedure: a 10-year single-institution experience
Section snippets
Material and methods
Permission to perform the health record review was obtained from the Research Ethics Board of The Hospital for Sick Children. The cardiovascular surgery database was reviewed for all patients having a stage-one Norwood operation between 1990 and 2000. The 10-year period was divided into three eras: era I, 1990 through 1993; era II, 1994 through 1997; and era III, 1998 into 2000.
From March 1990 to October 2000, 171 modified Norwood procedures were performed at The Hospital for Sick Children in
Results
A flowchart of the outcomes for the 171 neonates and infants having a modified Norwood procedure is shown in Figure 1. The overall hospital mortality rate for stage one palliation was 41% and did not differ between patients with a diagnosis of HLHS (mortality rate of 42%, 50/118) versus those with a diagnosis that was not HLHS (mortality rate of 36%, 19 of 53) (p = 0.50). Overall Kaplan-Meier survival is shown in Figure 2. The mortality rate for the stage-one procedure in the three
Mortality
The mortality rate after the stage-one modified Norwood procedure has been reported to be as high 40% to 50% 4, 6. With increased experience, survival has improved to 70% to 80% 6, 9, 10. In our experience, the overall unadjusted mortality rate is 40%. However, it has declined progressively, and in 2000 was 10%.
Risk factors for mortality
Reported risk factors for mortality include earlier era of operation 6, 9, older age at operation 6, 9, lower weight at operation 4, 6, anatomic subtype 2, 3, 14, diagnosis of HLHS
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