Key result
Normothermic Norwood cuts bypass times with similar in-hospital mortality compared to hypothermic approach.
Why the study?
Either deep hypothermia with circulatory arrest or hypothermic perfusion with antegrade selective cerebral perfusion is used during the Norwood procedure, but normothermic perfusion outcomes have not been compared.
Does the normothermic Norwood procedure improve early outcomes compared to the hypothermic Norwood procedure in patients with hypoplastic left heart syndrome?
Cohort (n=117)
Does the normothermic Norwood procedure improve early outcomes compared to the hypothermic Norwood procedure in patients with hypoplastic left heart syndrome?
Absolute Event Rate: 18.4% vs 14.9%
p-value: p=0.81
The normothermic Norwood procedure with selective cerebral perfusion is a safe and feasible alternative to the standard hypothermic approach, offering significantly shorter bypass and cross-clamp times without increasing in-hospital mortality.
Normothermic Norwood may shorten bypass times without raising mortality; hypothesis-generating and requires randomized trials before practice change.
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.
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Keizman et al. (2022) conducted a cohort in Hypoplastic left heart syndrome (n=117). Normothermic Norwood procedure with antegrade selective cerebral perfusion vs. Hypothermic Norwood procedure with antegrade selective cerebral perfusion was evaluated on In-hospital mortality (p=0.81). The normothermic Norwood procedure resulted in significantly shorter bypass times and similar in-hospital mortality compared to the hypothermic approach (18.4% vs 14.9%; P=0.81).
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