TY - JOUR
T1 - Normothermic Versus Hypothermic Norwood Procedure
AU - Keizman, Eitan
AU - Mishaly, David
AU - Ram, Eilon
AU - Urtaev, Soslan
AU - Tejman-Yarden, Shai
AU - Tirosh Wagner, Tal
AU - Serraf, Alain E.
N1 - Publisher Copyright:
© The Author(s) 2022.
PY - 2023/3
Y1 - 2023/3
N2 - Background: Either deep hypothermia with circulatory arrest or hypothermic perfusion with antegrade selective cerebral perfusion is used during the Norwood procedure for hypoplastic left heart syndrome. Normothermic perfusion has been described for pediatric patients. The aim of this study was to compare the early outcomes of patients undergoing the Norwood procedure with antegrade selective cerebral perfusion under hypothermia with the procedure under normothermia. Methods: From 2005 to 2020, 117 consecutive patients with hypoplastic left heart syndrome underwent the Norwood procedure: 68 (58.2%) under hypothermia and 49 (41.8%) under normothermia. Antegrade selective cerebral perfusion flow was adjusted to maintain right radial arterial pressure above 50 mm Hg, and a flow rate of 40 to 50 mL kg−1 min−1. Baseline characteristics, operative data, and postoperative outcomes including lactate recovery time were compared. Results: The baseline characteristics and cardiovascular diagnosis were similar in both groups. The normothermic group had a significantly shorter bypass time (in minutes) of 90.31 (±31.60) versus 123.63 (±25.33), a cross-clamp time of 45.24 (±16.35) versus 81.93 (±16.34), and an antegrade selective cerebral perfusion time of 25.61 (±13.84) versus 47.30 (±14.35) (P <.001). There were no statistically significant differences in the immediate postoperative course, or in terms of in-hospital mortality, which totaled 9 (18.4%) in the normothermic group, and 10 (14.9%) in the hypothermic group (P =.81). Conclusion: The normothermic Norwood procedure with selective cerebral perfusion is feasible and safe in terms of in-hospital mortality and short-term outcomes. It is comparable to the standard hypothermic Norwood with selective cerebral perfusion.
AB - Background: Either deep hypothermia with circulatory arrest or hypothermic perfusion with antegrade selective cerebral perfusion is used during the Norwood procedure for hypoplastic left heart syndrome. Normothermic perfusion has been described for pediatric patients. The aim of this study was to compare the early outcomes of patients undergoing the Norwood procedure with antegrade selective cerebral perfusion under hypothermia with the procedure under normothermia. Methods: From 2005 to 2020, 117 consecutive patients with hypoplastic left heart syndrome underwent the Norwood procedure: 68 (58.2%) under hypothermia and 49 (41.8%) under normothermia. Antegrade selective cerebral perfusion flow was adjusted to maintain right radial arterial pressure above 50 mm Hg, and a flow rate of 40 to 50 mL kg−1 min−1. Baseline characteristics, operative data, and postoperative outcomes including lactate recovery time were compared. Results: The baseline characteristics and cardiovascular diagnosis were similar in both groups. The normothermic group had a significantly shorter bypass time (in minutes) of 90.31 (±31.60) versus 123.63 (±25.33), a cross-clamp time of 45.24 (±16.35) versus 81.93 (±16.34), and an antegrade selective cerebral perfusion time of 25.61 (±13.84) versus 47.30 (±14.35) (P <.001). There were no statistically significant differences in the immediate postoperative course, or in terms of in-hospital mortality, which totaled 9 (18.4%) in the normothermic group, and 10 (14.9%) in the hypothermic group (P =.81). Conclusion: The normothermic Norwood procedure with selective cerebral perfusion is feasible and safe in terms of in-hospital mortality and short-term outcomes. It is comparable to the standard hypothermic Norwood with selective cerebral perfusion.
KW - Norwood procedure
KW - congenital heart surgery
KW - hypoplastic left heart syndrome
KW - hypothermia/circulatory arrest
UR - http://www.scopus.com/inward/record.url?scp=85151182463&partnerID=8YFLogxK
U2 - 10.1177/21501351221140330
DO - 10.1177/21501351221140330
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C2 - 36537725
AN - SCOPUS:85151182463
SN - 2150-1351
VL - 14
SP - 125
EP - 132
JO - World journal for pediatric & congenital heart surgery
JF - World journal for pediatric & congenital heart surgery
IS - 2
ER -