The importance of gestational age as a prognostic factor on Norwood Stage 1 outcome

Abstract

Objectives: The Norwood operation performed for hypoplastic left heart syndrome (HLHS) in the neonatal period remains to be a high-risk and difficult surgical procedure. It is known that preterm birth often accompanied by low birth weight is associated with high mortality and morbidity in these patients. Patients and Methods: The study included 54 patients who underwent the Norwood procedure in our clinic in the period between December 2012 and December 2019. Patient data were evaluated retrospectively; including gestational week, age, body weight, total bypass time, aortic cross-clamp time, extubation time, the length of stay in the intensive care unit, the length of hospital stay, and the preoperative and postoperative levels of urea, creatinine, ALT, AST, and platelet counts. Results: The body weight of the patients ranged from 2350 to 4500 grams with an average of 3296.3±486.7 grams. The age of the patients at the time of operation ranged from 1 to 374 days with an average of 30.31±70.51 days. The comparison of patients by term pregnancies resulted in no statistically significant differences but the comparison by gestational weeks revealed a statistically significant result. Conclusion: Preoperative risk factors affect prognosis more than the surgical technique and the treatment approach in patients with a functional single ventricle. When the gestational week was evaluated as a preoperative risk factor for its effects on the postoperative prognosis of stage 1 Norwood operation in our study, it was found that mortality decreased significantly after the 38.8th gestational week (272 gestational days).