What does this research mean for the field?

The Norwood procedure with a right ventricle-to-pulmonary artery shunt is associated with significantly lower 2-year mortality and improved psychomotor developmental outcomes compared to the modified Blalock-Taussig shunt in infants with hypoplastic left heart syndrome. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To compare two-year survival and neurodevelopmental outcomes between modified Blalock-Taussig shunt and right ventricle-to-pulmonary artery shunt eras in neonates undergoing the Norwood procedure.

August 23, 2026CirculationOpen Access

Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: hypoplastic left heart syndrome (n=94). Intervention: Norwood procedure with right ventricle-to-pulmonary artery (RVPA) shunt vs. Norwood procedure with modified Blalock-Taussig (MBTS) shunt. Primary outcome: 2-year mortality rate (p=0.002).

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Key result

RVPA shunt in the Norwood procedure is linked to ~63% lower 2-year mortality than MBTS.

P=0.002
n=94

Why the study?

Does the RVPA shunt improve 2-year survival and psychomotor outcomes compared to the MBTS shunt in neonates undergoing the Norwood procedure for hypoplastic left heart syndrome?

Population

94 neonates with hypoplastic left heart syndrome undergoing the Norwood procedure

Comparison

Norwood procedure with right… vs Norwood procedure with modified Blalock-Taussig…

Design

Cohort

Follow-up

2 years

Authors

JAJoseph AtallahPediatric Cardiology IDIrina DinuUniversity of Alberta AJAri R. JoffeUniversity of Alberta

Discussion

Member takes

Implication

The use of the RVPA shunt during the Norwood procedure for hypoplastic left heart syndrome is associated with improved 2-year survival and psychomotor development compared to the historical MBTS shunt.

Key Points

To compare two-year survival and neurodevelopmental outcomes between modified Blalock-Taussig shunt and right ventricle-to-pulmonary artery shunt eras in neonates undergoing the Norwood procedure.
Prospective cohort study of 94 neonates with hypoplastic left heart syndrome undergoing stage 1 Norwood palliation between September 1996 and July 2005.
Patients were analyzed across two consecutive eras: modified Blalock-Taussig shunt (n=62; 1996–2002) versus right ventricle-to-pulmonary artery shunt (n=32; 2002–2005).
Assessed early mortality, two-year mortality, independent predictors via multivariable Cox regression, and two-year neurodevelopment using the Bayley Scales of Infant Development-II.
Two-year mortality fell from 52% (32/62) in the modified Blalock-Taussig shunt era to 19% (6/32) in the right ventricle-to-pulmonary artery shunt era (P=0.002).
Psychomotor developmental index scores improved from a mean (SD) of 67 (19) to 78 (18) (P=0.029), whereas mental developmental index scores were 79 (18) versus 85 (18).
Postoperative highest serum lactate independently predicted two-year mortality across both surgical eras on multivariable Cox regression analysis.

Study Design

Type

Cohort (n=94)

Multicenter

Structured PICO

Does the RVPA shunt improve 2-year survival and psychomotor outcomes compared to the MBTS shunt in neonates undergoing the Norwood procedure for hypoplastic left heart syndrome?

Population

94 neonates with hypoplastic left heart syndrome undergoing the Norwood procedure, followed prospectively for 2 years.

Exposure

Norwood procedure with right ventricle-to-pulmonary artery (RVPA) shunt (n=32; 2002 to 2005 era)

Comparator

Norwood procedure with modified Blalock-Taussig (MBTS) shunt (n=62; 1996 to 2002 era)

Outcome

2-year survival and mental and psychomotor outcomes (Bayley Scales of Infant Development-II)hard clinical

Main Result

Absolute Event Rate: 19% vs 52%

p-value: p=0.002

Cite This Study

Atallah et al. (2008) conducted a cohort in hypoplastic left heart syndrome (n=94). Norwood procedure with right ventricle-to-pulmonary artery (RVPA) shunt vs. Norwood procedure with modified Blalock-Taussig (MBTS) shunt was evaluated on 2-year mortality rate (p=0.002). The Norwood procedure using the RVPA shunt was associated with a lower 2-year mortality rate (19% vs 52%, P=0.002) and improved psychomotor development compared to the MBTS shunt.

synapsesocial.com/papers/6a8b63bf4307c6fbfc8042e7 https://doi.org/10.1161/circulationaha.107.741579

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Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Two-Year Survival and Mental and Psychomotor Outcomes After the Norwood Procedure

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider