| Evolving strategies and improving outcomes of the modified norwood procedure: a 10-year single-institution experience. | |
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MedLine Citation:
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PMID: 11603459 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: This study reviews our 10-year experience with the modified Norwood procedure to determine its early and midterm outcomes. The focus is on the impact of evolving management strategies and accumulated institutional experience. METHODS: A modified Norwood operation was performed in 171 infants over a 10-year period. Sixty-eight percent of the infants were male, the median age at operation was 6 days (range 1 to 175 days), and the median weight was 3.3 kg (range 1.7 to 4.8 kg). 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. Outcomes and risk factors for mortality were sought. RESULTS: Hypoplastic left heart syndrome or a variant was the primary diagnosis in 118 infants (69%). The overall 5-year survival rate was 43%. Multivariate analysis revealed that only need of preoperative ventilatory support, earlier date of operation, and lower weight at operation were significant independent predictors of increased time-related mortality. Morphologic features such as a diagnosis other than hypoplastic left heart syndrome, ascending aortic size, and noncardiac anomalies were not significantly associated with an increased risk of death. The hospital survival rate for stage-one palliation in era III was 82%, significantly better than that in the preceding eras (p < 0.001). Attrition between stages one and two accounted for a 15% mortality rate among hospital survivors. CONCLUSIONS: With increasing experience and improvements in perioperative care and surgical technique, good outcomes can be expected for the first-stage modified Norwood procedure. Greater monitoring of patients in the interstage period may reduce interval mortality and improve overall survival. |
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Authors:
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T Azakie; S L Merklinger; B W McCrindle; G S Van Arsdell; K J Lee; L N Benson; J G Coles; W G Williams |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 72 ISSN: 0003-4975 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2001 Oct |
Date Detail:
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Created Date: 2001-10-17 Completed Date: 2001-12-04 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1349-53 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, The Hospital for Sick Children, University of Toronto School of Medicine, Ontario, Canada. tony.azakie@utoronto.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Female Follow-Up Studies Heart Transplantation Humans Hypoplastic Left Heart Syndrome / mortality, surgery* Infant Infant, Newborn Male Palliative Care* Postoperative Complications / mortality Reoperation Risk Factors Survival Rate Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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