Norwood Procedure

The Norwood procedure is a testament to the pioneering work of William (Bill) I Norwood MD, PhD, a distinguished congenital heart surgeon whose innovative surgical technique transformed the prognosis for infants born with hypoplastic left heart syndrome (HLHS) in the 1980s. Before this surgical breakthrough, neonates with HLHS faced a dire fate without any viable treatment options. However, this surgical innovation paved the way for their survival, marking a pivotal moment in congenital heart surgery history. The Norwood procedure has since emerged as a cornerstone operation, cataloged by national congenital heart surgery databases and performed extensively across numerous institutions worldwide; the 2018 Society of Thoracic Surgeons report revealed that more than 2000 Norwood operations were performed at approximately 100 institutions.

While the initial procedures were conducted at Boston Children's Hospital, subsequent procedural modifications refined the specific steps and materials, reflecting ongoing advancements in surgical practice. Among the notable controversies surrounding the Norwood procedure is selecting a suitable shunt for establishing pulmonary blood flow, with variations between the modified Blalock-Taussig-Thomas (mBTT) and the right ventricle to pulmonary artery (RV-PA) Sano shunts. This debate prompted the multicenter randomized control Single Ventricle Reconstruction (SVR) trial, which explored the clinical outcomes of different shunts in HLHS repairs. Notably, midterm follow-up from the SVR trial revealed no significant difference in outcomes, underscoring the complexity and importance of this decision in patient care. Moreover, the survival of patients following the first-stage Norwood procedure opens doors for subsequent surgical interventions, including superior cavopulmonary connection and completion Fontan (total cavopulmonary connection) procedures, offering hope for improved long-term outcomes and quality of life.