Initial experience with the Norwood procedure for aortic atresia in the hypoplastic left heart

A. J.J. Bogers, I. M.E. Frohn-Mulder, M. Witsenburg, P. L. De Jong, K. F.M. Joosten, H. J. De Boer, J. Hess

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Despite a possible learning curve, programs performing a limited number of Norwood procedures for hypoplastic left heart syndrome (HLHS) may nevertheless produce adequate results. Regarding this our experience with newborns with HLHS and staged reconstructive surgery for this anomaly is described. Methods: Retrospective analysis of all 53 consecutive patients with aortic atresia in HLHS was carried out. Thirty patients (57%) were not eligible for surgical palliation, in 23 patients (43%) a Norwood procedure was performed. Results. There was a significant improvement in both operative mortality as well as 30 day mortality comparing the first half of the series with the second half (operative mortality 6/12 versus 1/11 or 50% versus 9%, p < 0.05 and 30 day mortality 9/12 versus 2/11 or 75% versus 18%, p < 0.05). Early survival was also correlated with smaller shunt size (survivors shunt size 4 mm/5 mm 10/2 versus nonsurvivors shunt size 4 mm/5 mm 2/9, p < 0.05). In 4 patients additional surgery was done before planned staged surgery. Four patients died before planned staged surgery. One patient was lost to follow up. The remaining 7 patients all entered further staged surgery. Conclusion: Staged reconstruction starting with the Norwood procedure has significantly improved the intermediate survival for patients with HLHS. Improvements can be made in preoperative treatment and selection. Further improvements can also be made in early as well as late postoperative care after the Norwood procedure. Nevertheless, centres, which are prepared to invest adequate time and energy in order to get the required expertise in dealing with all aspects of Norwood operations, may contribute positively to improve the outcome for newborns with HLHS.

Original languageEnglish
Pages (from-to)67-70
Number of pages4
JournalCardiovascular Engineering
Issue number2
StatePublished - 1998
Externally publishedYes


  • Hypoplastic left heart syndrome
  • Norwood procedure


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