Evolving strategies and improving outcomes of Norwood stage one reconstruction: a decade experience of a single institution in Taiwan.

AIM

The aim of this study was to define the improvement in short-term outcome and risk factors of Norwood stage one reconstruction for hypoplastic left heart syndrome (HLHS) in Taiwan, after implementing new perioperative management strategies.

METHODS

Data were retrieved from a retrospective chart review of patients with HLHS treated between July 1997 and July 2007. Since we implemented new perioperative strategies in 2004, we divided our patients into two groups, early era (1997-2003) and late era (2004-2007), and compared the outcome.

RESULTS

We enrolled 48 patients. In the early era group (n=28), the diagnosis was confirmed by cardiac catheterization and controlled ventilation was used to manipulate the balance between systemic and pulmonary blood flow. The survival rate was only 17.9% (5/28). Surgery was performed at 15.2+/-10.7 days, which was significantly later than in the late era group (4.6+/-4.0 days, n=20). A lower preoperative shock and more prenatal diagnoses were recorded for the late era group. RV-PA conduit was used in 17 patients in the late era group of which 12 (70.6%) survived to be discharged from hospital. The risk factor was significant TR (tricuspid regurgitation).

CONCLUSIONS

With our contemporary perioperative management and change in surgical strategy, survival after first-stage palliation has improved. We believe that our HLHS experience is valuable for low volume centers and also for Asian cohorts.