ORIGINAL ARTICLE   

Minerva Pediatrics 2024 August;76(4):498-506

DOI: 10.23736/S2724-5276.21.06133-4

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

The impact of a standardized perioperative management on hospital mortality after the Norwood procedure in a low volume center: results and perspectives

Floriana FERRARI ¹ ✉, Mirco NACOTI ¹, Alessandra CAROBBIO ², Moreno FAVARATO ¹, Giovanni B. DI DEDDA ¹, Ezio BONANOMI ¹

¹ Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy; ² FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy

BACKGROUND: Mortality of newborns with Hypoplastic Left Heart Syndrome (HLHS) is mainly concentrated after Norwood procedure (NP) stage 1 palliation (S1P) and between S1P and stage 2 palliation (S2P). Standardized management of these patients may help to control hospital mortality. Aim of the study was to evaluate the impact on hospital mortality of a standardized perioperative management (SPM) for newborns requiring S1P in a low volume center for NP.
METHODS: A consecutive series of patients undergoing S1P from January 1, 2002 to December 31, 2006 were retrospectively compared, by a “before and after” design, with those receiving a SPM (i.e. use of selective cerebral perfusion, near infrared spectroscopy, delayed sternal closure, modified ultrafiltration) from January 1^st, 2007 to December 31^st, 2018. Demographic, intraoperative and postoperative characteristics were collected. Univariate and multivariate analyses assessed differences before and after SPM.
RESULTS: Ninety-one newborns underwent S1P in the considered period; of 74 eligible patients, 25 did not receive SPM, while 49 received SPM. Hospital mortality after S1P was 31% (CI 21-44%). The introduction of a SPM did not affect hospital mortality both at the univariate-(28% vs. 29%, P=0.959) and at the multivariate analysis (HR 1.85, P=0.62). Mortality was 12% (CI 6-25%) between hospital discharge after S1P and S2P and 8% (CI 3-22%) between S2P and S3P.
CONCLUSIONS: The use of a SPM for HLHS newborns requiring S1P was not effective in reducing hospital mortality in a low volume center. We suggest a collaboration between Italian Pediatric Cardiac Centers to manage HLHS patients.

KEY WORDS: Newborn infant; Hypoplastic left heart syndrome; Norwood procedures; Cardiac surgical procedures; Mortality