Original article: cardiovascularRoutine mechanical ventricular assist following the Norwood procedure—improved neurologic outcome and excellent hospital survival
Section snippets
Material and methods
Beginning in January, 2001, thirteen consecutive infants at Doernbecher Children's Hospital (Oregon Health & Science University, Portland, Oregon [OHSU]) and five at Kosair Children's Hospital (University of Louisville, Louisville, Kentucky [UL]) underwent Norwood for HLHS or Damus-Kaye-Stansel (with arch augmentation) for variations of HLHS (Table 1). They were routinely placed on mechanical ventricular assist immediately at the end of their procedure. Institutional Review Board approval was
Results
All patients were successfully weaned off from ventricular support (Table 3), but two patients (both nonsurvivors) had hemodynamic instability and required urgent replacement on mechanical support within a short time of removal from VAD. All the others recovered and were eventually discharged from the hospital (hospital survival 16/18 = 89% with 95% confidence interval of 63.9% to 98.1%). Complications related to VAD were minimal. One patient (OHSU) developed mediastinal infection and was
Comment
Despite recent improvement in outcomes at some institutions, hospital survival following Norwood procedure continues to present a challenge to many centers 3, 9, 20. Three-year survival is approximately 66% even in the most experienced centers 10, 21. Reasons for late mortality may relate in part to shunt thrombosis, coronary insufficiency, mortality from subsequent procedures, and complications from neurologic impairment. Furthermore, the quality of neurologic outcome is questionable for many
Acknowledgements
As in any multi-institutional study, active participation is provided by more individuals than can be realistically included in the list of authors. The authors gratefully appreciate the significant input from numerous others, including (and not limited to) Dana Braner, MD, Robert Steelman, MD, Laura Ibsen, MD, Miles Ellenby, MD, Aileen Kirby, MD, Kenneth Tegtmeyer, MD, Grant Burch, MD, Mark Reller, MD, Mary Rice, MD, Paul Droukas, MD, Seshardri Balaji, MD, Mary Minette, MD, Brent Barber, MD,
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