Long-term outcomes of hypoplastic left heart syndrome with analysis of the Norwood procedure in infants following bilateral pulmonary artery bandingCentral MessagePerspective
Objective: To investigate the early and long-term outcomes of the deferred Norwood procedure by bilateral pulmonary artery banding (BPAB) versus the neonatal Norwood procedure. Methods: This retrospective study examined 46 patients with hypoplastic left heart syndrome and its variants undergoing the...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | JTCVS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273623002188 |
| _version_ | 1797385045982314496 |
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| author | Yoshikiyo Matsunaga, MD Fumiaki Shikata, MD, PhD Norihiko Oka, MD, PhD Toru Okamura, MD, PhD Takahiro Tomoyasu, MD, PhD Masahiro Kaneko, MD, PhD Takamichi Inoue, MD Kenta Matsui, MD Kagami Miyaji, MD, PhD |
| author_facet | Yoshikiyo Matsunaga, MD Fumiaki Shikata, MD, PhD Norihiko Oka, MD, PhD Toru Okamura, MD, PhD Takahiro Tomoyasu, MD, PhD Masahiro Kaneko, MD, PhD Takamichi Inoue, MD Kenta Matsui, MD Kagami Miyaji, MD, PhD |
| author_sort | Yoshikiyo Matsunaga, MD |
| collection | DOAJ |
| description | Objective: To investigate the early and long-term outcomes of the deferred Norwood procedure by bilateral pulmonary artery banding (BPAB) versus the neonatal Norwood procedure. Methods: This retrospective study examined 46 patients with hypoplastic left heart syndrome and its variants undergoing the Norwood procedure for single ventricle physiology between 2004 and 2022 at 3 institutions. The patients were divided into 2 groups: neonatal Norwood procedure (group N; n = 23) and staged Norwood procedure in infants following BPAB (group I; n = 23). Preoperative risk factors, surgical results, survival rates, Fontan candidacy, and long-term complications were compared. Results: Early survival rates after the Norwood procedure were 91.3% (21 of 23) in both groups. Late survival rates after the Norwood procedure were similar at the 10-year follow-up (group N, 76.3%; group I, 68.7%; P = .63). Fontan completion rates also were comparable in the 2 groups (group N, 77.8%; group I, 85.7%; P = .67). Group N showed a higher median pulmonary artery (PA) index before bidirectional cavopulmonary connection (group N, 177 [interquartile range (IQR), 147-243] mm2/m2; group I, 152 [IQR, 146-163] mm2/m2; P = .03); this trend continued until 5 years after Fontan completion (P = .01). Group N also had a lower rate of freedom from protein-losing enteropathy (PLE) at 9.0 years after the Fontan operation (90.0% vs 52.5% for group I; P = .04), although the incidences of other Fontan-associated events were not significantly different. Conclusions: Fontan candidacy and survival rates were similar regardless of the timing of the Norwood procedure. Early performance of the Norwood procedure may lead to lower rates of late Fontan-associated events, such as PLE. |
| first_indexed | 2024-03-08T21:48:27Z |
| format | Article |
| id | doaj.art-cebb6cd07aaf4acdbca95be44d903135 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-03-08T21:48:27Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-cebb6cd07aaf4acdbca95be44d9031352023-12-20T07:38:06ZengElsevierJTCVS Open2666-27362023-12-0116675688Long-term outcomes of hypoplastic left heart syndrome with analysis of the Norwood procedure in infants following bilateral pulmonary artery bandingCentral MessagePerspectiveYoshikiyo Matsunaga, MD0Fumiaki Shikata, MD, PhD1Norihiko Oka, MD, PhD2Toru Okamura, MD, PhD3Takahiro Tomoyasu, MD, PhD4Masahiro Kaneko, MD, PhD5Takamichi Inoue, MD6Kenta Matsui, MD7Kagami Miyaji, MD, PhD8Department of Cardiovascular Surgery, Kitasato University Hospital, Kanagawa, Japan; Cardiovascular Surgery, Gunma Children's Medical Center, Gunma, JapanDepartment of Cardiovascular Surgery, Kitasato University Hospital, Kanagawa, Japan; Address for reprints: Fumiaki Shikata, MD, PhD, Department of Cardiovascular Surgery, Kitasato University, School of Medicine, Kitasato 1-15-1, Sagamihara, 252-0374, Japan.Pediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center, Tochigi, JapanCardiovascular Surgery, Gunma Children's Medical Center, Gunma, JapanPediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center, Tochigi, JapanPediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center, Tochigi, JapanPediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center, Tochigi, JapanDepartment of Cardiovascular Surgery, Kitasato University Hospital, Kanagawa, Japan; Pediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center, Tochigi, JapanDepartment of Cardiovascular Surgery, Kitasato University Hospital, Kanagawa, JapanObjective: To investigate the early and long-term outcomes of the deferred Norwood procedure by bilateral pulmonary artery banding (BPAB) versus the neonatal Norwood procedure. Methods: This retrospective study examined 46 patients with hypoplastic left heart syndrome and its variants undergoing the Norwood procedure for single ventricle physiology between 2004 and 2022 at 3 institutions. The patients were divided into 2 groups: neonatal Norwood procedure (group N; n = 23) and staged Norwood procedure in infants following BPAB (group I; n = 23). Preoperative risk factors, surgical results, survival rates, Fontan candidacy, and long-term complications were compared. Results: Early survival rates after the Norwood procedure were 91.3% (21 of 23) in both groups. Late survival rates after the Norwood procedure were similar at the 10-year follow-up (group N, 76.3%; group I, 68.7%; P = .63). Fontan completion rates also were comparable in the 2 groups (group N, 77.8%; group I, 85.7%; P = .67). Group N showed a higher median pulmonary artery (PA) index before bidirectional cavopulmonary connection (group N, 177 [interquartile range (IQR), 147-243] mm2/m2; group I, 152 [IQR, 146-163] mm2/m2; P = .03); this trend continued until 5 years after Fontan completion (P = .01). Group N also had a lower rate of freedom from protein-losing enteropathy (PLE) at 9.0 years after the Fontan operation (90.0% vs 52.5% for group I; P = .04), although the incidences of other Fontan-associated events were not significantly different. Conclusions: Fontan candidacy and survival rates were similar regardless of the timing of the Norwood procedure. Early performance of the Norwood procedure may lead to lower rates of late Fontan-associated events, such as PLE.http://www.sciencedirect.com/science/article/pii/S2666273623002188bilateral pulmonary artery bandingcomplications associated with Fontan circulationhypoplastic left heart syndromeNorwood procedure |
| spellingShingle | Yoshikiyo Matsunaga, MD Fumiaki Shikata, MD, PhD Norihiko Oka, MD, PhD Toru Okamura, MD, PhD Takahiro Tomoyasu, MD, PhD Masahiro Kaneko, MD, PhD Takamichi Inoue, MD Kenta Matsui, MD Kagami Miyaji, MD, PhD Long-term outcomes of hypoplastic left heart syndrome with analysis of the Norwood procedure in infants following bilateral pulmonary artery bandingCentral MessagePerspective JTCVS Open bilateral pulmonary artery banding complications associated with Fontan circulation hypoplastic left heart syndrome Norwood procedure |
| title | Long-term outcomes of hypoplastic left heart syndrome with analysis of the Norwood procedure in infants following bilateral pulmonary artery bandingCentral MessagePerspective |
| title_full | Long-term outcomes of hypoplastic left heart syndrome with analysis of the Norwood procedure in infants following bilateral pulmonary artery bandingCentral MessagePerspective |
| title_fullStr | Long-term outcomes of hypoplastic left heart syndrome with analysis of the Norwood procedure in infants following bilateral pulmonary artery bandingCentral MessagePerspective |
| title_full_unstemmed | Long-term outcomes of hypoplastic left heart syndrome with analysis of the Norwood procedure in infants following bilateral pulmonary artery bandingCentral MessagePerspective |
| title_short | Long-term outcomes of hypoplastic left heart syndrome with analysis of the Norwood procedure in infants following bilateral pulmonary artery bandingCentral MessagePerspective |
| title_sort | long term outcomes of hypoplastic left heart syndrome with analysis of the norwood procedure in infants following bilateral pulmonary artery bandingcentral messageperspective |
| topic | bilateral pulmonary artery banding complications associated with Fontan circulation hypoplastic left heart syndrome Norwood procedure |
| url | http://www.sciencedirect.com/science/article/pii/S2666273623002188 |
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