Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; Cardio-thoracic Surgery Department, Mansoura University, Mansoura, Egypt.
Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
J Thorac Cardiovasc Surg. 2020 Mar;159(3):1040-1048. doi: 10.1016/j.jtcvs.2019.07.154. Epub 2019 Nov 22.
We present the evolution of Norwood operation outcomes and practice pattern changes over 15 years from a single institution in Saudi Arabia. We intended to identify time trends in patient selection, procedural details, and outcome predictors over time.
Patients who underwent a Norwood operation (n = 145) between 2003 and 2018 with the use of a Blalock-Taussig shunt (BT group; n = 72), right ventricle to pulmonary artery shunt (Sano group; n = 66), or a primary cavopulmonary shunt (CPS group; n = 7) were included. The study outcomes were operative mortality, long-term survival, and multistate transition to CPS, Fontan, and death.
Median age was 29 days. Predictors of operative mortality were lower weight (P = .026), and longer bypass time (P = .014), whereas age, and type of shunt were not. Predictors of improved long-term survival were greater weight at operation (P = .0016), later era (P = .006), and shorter bypass time (P = .001). The multistate model revealed that patients with lower weight were more likely to undergo Sano versus BT (P < .001), and if BT was chosen in such patients, they were more likely to die (P = .027). The likelihood of receiving Sano shunt was 3-fold greater in the recent era (P = .003).
Improved outcomes of the Norwood operation are evident in the recent era and with Sano shunt, especially in patients of smaller weight. Late presentation or older age is not a contraindication to Norwood operation. The incorporation of a primary CPS at stage one operation is feasible in selected patients.
我们展示了在沙特阿拉伯的一家单一机构中，15 年来诺伍德手术结果和实践模式的演变。我们旨在确定随时间推移患者选择、手术细节和结果预测因素的时间趋势。
我们纳入了 2003 年至 2018 年间接受诺伍德手术的 145 名患者（使用 Blalock-Taussig 分流术[BT 组]的 72 名患者、右心室至肺动脉分流术[Sano 组]的 66 名患者和直接腔肺分流术[CPS 组]的 7 名患者）。本研究的结果是手术死亡率、长期生存率以及多状态向 CPS、Fontan 和死亡的转移。
中位年龄为 29 天。手术死亡率的预测因素是体重较低（P =.026）和体外循环时间较长（P =.014），而年龄和分流术类型不是。长期生存率提高的预测因素是手术时体重较大（P =.0016）、时代较新（P =.006）和体外循环时间较短（P =.001）。多状态模型显示，体重较低的患者更有可能接受 Sano 而不是 BT（P <.001），并且如果选择 BT，他们更有可能死亡（P =.027）。在近期时代，接受 Sano 分流术的可能性增加了 3 倍（P =.003）。
在近期时代，Sano 分流术尤其在体重较小的患者中，诺伍德手术的结果明显改善。晚期就诊或年龄较大不是诺伍德手术的禁忌症。在选定的患者中，在一期手术中加入直接 CPS 是可行的。
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