Síndrome da hipoplasia do coração esquerdo: a influência da estratégia cirúrgica nos resultados

Abstract

SummaryObjectives: To report a surgical strategy for the Norwood procedure in the hypoplastic left heart syndrome (HLHS) that enables short hypothermic circulatory arrest time and aortic arch reconstruction with autologous pericardium patch, and to compare the results of the modified Blalock- Taussig Results: In-hospital survival for the entire cohort was 74.64%, or 67.57% and 82.35% for the mBT shunt and RV-PA conduit groups, respectively (p=0.1808). Mortality rates between the first and second palliation stages were 40% and 4.4% for the mBT shunt and RV-PA conduit groups, respectively (p=0.0054). Hypothermic circulatory arrest times were 45.79±1.99 min and 36.62±1.62min (p=0.0012), respectively. Late coarctation of the aorta occurred in five patients (7.2%).Conclusions: This surgical strategy resulted in short circulatory arrest time, low mortality and favorable morphology of the neoaorta, with low incidence of late coarctation of the aorta. The higher rate of survival to first palliation stage with the RV-PA conduit was not significant, but interstage mortality was statistically lower when compared with the modified Blalock-Taussig shunt procedure.

Complicações que aumentam o tempo de permanência na unidade de terapia intensiva na cirurgia cardíaca

“…The prolonged CPB, in addition to systemic inflammation, predisposes to postoperative complications, especially respiratory [3,4,7,16,[31][32][33][34][35][36] and the need to use the IAB reflects hemodynamic instability [2,3,16,30 , 31.37]. CABG surgery without CPB was initially performed in 1967 by Kolessov.…”

Classic form of hypoplastic left heart syndrome diagnosed post-natally: an autopsy report

“…Currently, the three-stage palliative cardiac surgery, described by Norwood et al,22 has been the therapy of choice for most cases. Norwood et al,23 published the first case-series of operations between 1979 and 1981 with favorable outcomes, and since then this operation has been improved and recommended 24. The first stage, known as Norwood surgery, is undertaken after birth and consists of connecting the main pulmonary artery to the aortic arch, which was previously expanded, with a polytetrafluoroethylene (PTFE) graft, thus forming a new aorta.…”

“…The first stage, known as Norwood surgery, is undertaken after birth and consists of connecting the main pulmonary artery to the aortic arch, which was previously expanded, with a polytetrafluoroethylene (PTFE) graft, thus forming a new aorta. Pulmonary perfusion is maintained by a tubular PTFE graft anastomosed in the right subclavian and right pulmonary arteries 5 , 24 , 25. Interatrial septal defect may be widened in this procedure.…”

“…Norwood et al, 23 published the first case-series of operations between 1979 and 1981 with favorable outcomes, and since then this operation has been improved and recommended. 24 The first stage, known as Norwood surgery, is undertaken after birth and consists of connecting the main pulmonary artery to the aortic arch, which was previously expanded, with a polytetrafluoroethylene (PTFE) graft, thus forming a new aorta. Pulmonary perfusion is maintained by a tubular PTFE graft anastomosed in the right subclavian and right pulmonary arteries.…”

“…Pulmonary perfusion is maintained by a tubular PTFE graft anastomosed in the right subclavian and right pulmonary arteries. 5 , 24 , 25 Interatrial septal defect may be widened in this procedure. In 2003, Sano et al 26 , 27 published modifications in the Norwood technique with outcome improvement.…”