ArticleInterdisciplinary cardiovascular and thoracic surgery2026
Outcomes of Delayed Norwood Operation in High-Risk Patients-Time to Reconsider the Dogma of a Primary Norwood Operation?
Article in Interdisciplinary cardiovascular and thoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThe delayed Norwood (DN) approach, preceded by bilateral pulmonary artery banding (bPAB), has emerged as a strategy to improve outcomes in high-risk infants by addressing neonatal haemodynamic instability and organ immaturity.
methodsThis single-centre, retrospective study analysed 20 consecutive patients with hypoplastic left heart syndrome/variants and multiple risk factors who underwent a DN operation following bPAB between 2019 and 2024.
resultsBilateral pulmonary artery banding was performed at a median age of 2.5 days (interquartile range [IQR]: 2-4). Preoperative risk factors included prematurity (35%), low birth weight <2.5 kg (25%), non-cardiac comorbidities (25%), genetic syndromes (50%), preoperative cardiogenic shock (35%), and restrictive atrial septum (25%). The median age at DN was 36 days (IQR: 29-79), with an operative survival rate of 75%. Patients who underwent the DN within 4 weeks of bPAB did not require any pulmonary artery (PA) reinterventions. Median lactate clearance time was 8 hours (IQR: 5-18), and the median vasoactive inotropic score decreased by 47% within 48 hours postoperatively. Cerebral near-infrared spectroscopy values improved in patients without postoperative extracorporeal membrane oxygenation (ECMO) support from 53% to 58% and 63% at 0, 12, and 36 hours, respectively.
conclusionsThe DN approach, preceded by initial bPAB in a high-risk patient cohort, achieved surgical outcomes comparable to those of lower-risk patients undergoing primary Norwood operation. A DN procedure around 4-6 weeks of following bPAB may improve survival rates in high-risk patients with a reduction in surgical or catheter-based reinterventions.
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