Complications after the Norwood operation: an analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database

Background: Limited multicenter data exist regarding the prevalence of postoperative complications after the Norwood operation and their associated mortality risk.

Methods: We evaluated infants in The Society of Thoracic Surgeons Congenital Heart Surgery Database who underwent the Norwood operation from 2000 to 2009. The prevalence of postoperative complications after the Norwood operation and associated in-hospital mortality were described. Patient factors associated with complications were evaluated in multivariable analyses.

Results: A total of 2,557 patients from 53 centers were included. Median age at operation was 6 days (interquartile range, 4 to 9 days) and 90% had a right dominant ventricle. Overall mortality was 22%, and 75% had 1 complication or more. Mortality increased with increasing number of complications: 1 complication, 17%; 2 complications, 21%; 3 complications, 26%; 4 complications, 33%; and 5 or more complications, 45%. Renal and cardiovascular complications carried the greatest mortality risk. Patient factors associated with 1 complication or more included weight less than 2.5 kg (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2 to 2.1), single right versus single left ventricle (OR, 1.4; 95% CI, 1.01 to 2.0), preoperative shock (OR, 1.5; 95% CI, 1.1 to 2.1), non-cardiac/genetic abnormality (OR, 1.5; 95% CI, 1.2 to 1.9), and preoperative mechanical ventilatory (OR, 1.3; 95% CI, 1.03 to 1.6) or circulatory (OR 4.0; 95%CI, 1.6 to 10.2) support.

Conclusions: Complications after the Norwood operation are common, carry significant mortality risk, and are associated with several preoperative patient characteristics. These data may aid in providing prognostic information to families and in guiding quality improvement initiatives.