Fate of ventricular and valve performance following early bidirectional Glenn procedure after Norwood operation controlled for hypoplastic left heart syndome anatomic subtype

Early superior cavopulmonary connection with pre-operative CT shows comparable outcomes for infants following norwood palliation

OBJECTIVES

There is increasing evidence that performing superior cavopulmonary connection at 3 months reduces mortality: reducing the risky 'interstage' period, volume off-loading the ventricle and reducing coronary steal, hopefully preserving ventricular function. Our objective was to describe our experience of early superior cavopulmonary connection with preoperative CT assessment compared to later connection at 6 months.

METHODS

Patients undergoing Norwood procedure from 2005 to 2020 were divided into Two eras were described and compared. Era 1 from 2005-2016 when superior cavopulmonary connection was undertaken at 6 months: and era 2 (2017-2020) when an earlier operation was performed. Demographics, mortality (interstage, early and late following superior cavopulmonary connection) and data on post-operative course and complications were recorded.

RESULTS

In era 1, 191 patients underwent Norwood (120 survivors to superior cavopulmonary connection) and 28 patients (23 survivors) in era 2. There were no significant differences in the demographics. Interstage mortality was 17.8% in era 1 and 8.0% in era 2 but not significantly significant (p = 0.22). The median (IQR) age at pre-imaging and superior cavopulmonary connection was significantly lower: 99 (81-120) vs 77 (47-102) days and 175 (117-208) vs 106 (102-122) day in era 1 vs era 2 (P < 0.005). Weight was lower at superior cavopulmonary connection in era 2 (mean (SD) 6.2 kg (1.2) vs 5.1 kg (0.8), p < 0.05). Intubation time and total length of stay were not statistically different. Median Intensive care unit stay was statistically significantly longer, but not clinically significant): 2.5 (2-4) vs 3 (3-5) days respectively (p < 0.05). There was no significant difference in early or late mortality, rates of diagnostic or interventional catheter, post-operative MRI/CT or stroke. Logistic regression analysis demonstrates increasing age at superior cavopulmonary connection was associated with increased chance of stroke or early death (p = 0.043).

CONCLUSIONS

Early superior cavopulmonary connection with CT assessment is feasible and although intensive care unit length of stay was slightly longer there was no change in the overall length of stay and no change in post-operative mortality or complications.