The Norwood Stage 1 procedure - conduct of perfusion: 2017 Survey results from NPC-QIC member institutions

Abstract

Hypoplastic left heart syndrome (HLHS) is a rare and severe congenital cardiac defect. Approximately 1000 infants are born with HLHS in the United States every year. Healthcare collaboratives over the last decade have focused on sharing patient experiences and techniques in an effort to improve outcomes. In 2010, cardiologists and patient families joined together to improve the care of HLHS patients by forming the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC). Sixty-six of the approximately 110 institutions caring for patients with HLHS in the United States and Canada are now members of NPC-QIC. In 2017, cardiovascular perfusionists joined the collaborative as another specialty involved in the care of HLHS patients. Perfusionists and cardiac surgeons developed the collaborative's first conduct of perfusion survey for the Norwood Stage 1 procedure, specifically targeting the provision of cardiopulmonary bypass for patients with HLHS. This manuscript discusses the results of this survey, unveiling a significant variance in the conduct of perfusion for this patient population.

Myocardial protection in paediatric cardiac surgery: building an evidence-based strategy

“…del Nido cardioplegia is thereby customised to reduce the impact of ischaemiareperfusion on the immature myocardium. Combined with the need for only a single dose in most cases, reducing interruptions to surgical flow, has led to its increasing popularity in the United States, with a recent survey finding it is preferred by 76% of centres performing complex surgery in neonates [12].…”

“…Many surgeons use their 'standard' approach to cardioplegia in most if not all cases, determined by their personal preferences and local practice [12,[14][15][16].…”

“…Combined with the need for only a single dose in most cases, reducing interruptions to surgical flow has led to its increasing popularity in the US, with a recent survey finding it is preferred by 76% of centres performing complex surgery in neonates. 12 …”

“…Many surgeons use their “standard” approach to cardioplegia in most if not all cases, determined by their personal preferences and local practice. 12 , 14 – 16 Nevertheless, patients differ by age, presence and extent of cyanosis, and a multitude of genetic factors. For this reason, a one-size-fits-all approach is unlikely to be optimal.…”