Ali Can HATEMİ, Ergin ARSLANOĞLU, Kenan Abdurrahman KARA, Berra Zümrüt TAN, Ömer Faruk ŞAVLUK, Fatma UKİL IŞILDAK, Eylem TUNÇER, Nihat ÇİNE, Hakan CEYRAN

Gestasyonel Haftanın Norwood Stage 1 Sonuçlarına Prognostik Etkisi

Giriş: Hipoplastik sol kalp sendromu olan hastalarda yenidoğan döneminde yapılan norwood prosedürü halen riskli ve zor bir cerrahi işlemdir. Bu hastalarda preterm doğum ve preterm doğuma sıklıkla eşlik eden düşük doğum ağırlığının mortalite ve morbiditeyi artırdığı bilinmektedir. Hastalar ve Yöntem: Çalışmaya Aralık 2012-Aralık 2019 tarihleri arasında kliniğimizde Norwood prosedürü uygulanan 54 hasta dahil edilmiştir. Hastaların gestasyonel hafta, yaş, kilo, total baypas süresi, aortik kross klemp süresi, ekstübasyon zamanı, yoğun bakım kalış ve servis yatış süreleri, preoperatif, postoperatif üre, kreatinin, alanin aminotransferaz, aspartat aminotransferaz, trombosit değerleri retrospektif olarak değerlendirilmiştir. Bulgular: Hastaların kilo değeri 2350 ile 4500 gram arasında değişmekte olup ortalama 3296.3 ± 486.7 gram bulunmuştur. Hastaların operasyon sırasındaki yaşı 1 ile 374 gün arasında değişmekte olup ortalama 30.31 ± 70.51 gün bulunmuştur. Hastalar termlere göre kıyaslandıklarında istatistiksel olarak anlamlı sonuç bulunmamış, fakat gestasyonel haftaya göre kıyaslandıklarında istatistiksel olarak anlamlı sonuç elde edilmiştir. Sonuç: Fonksiyonel tek ventriküle sahip hastalarda preoperatif risk faktörleri prognoza cerrahi teknik ve tedavi yaklaşımından daha fazla etkilir. Çalışmamızda preoperatif risk faktörlerinden biri olan gestasyonel hafta ile norwood stage 1 operasyonun postoperatif prognozu açısından karşılaştırıldığında 38,8. gestasyonel haftadan (272 gestasyonel gün) sonra mortalite anlamlı olarak düşmüştür.

The Importance of Gestational Age as a Prognostic Factor on Norwood Stage 1 Outcome

Introduction: The Norwood operation performed for hypoplastic left heart syndrome 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, alanine aminotransferase, aspartate aminotransferase, 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).

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1. Lev M. Pathologic anatomy and interrelationship of hypoplasia of the aortic tract complexes. Lab Invest 1952;1:61-70.
2. Noonan JA, Nadas AS. The hypoplastic left heart syndrome; an analysis of 101 cases. Pediatr Clin North Am 1958;5:1029-56.
3. Doty DB, Knott HW. Hypoplastic left heart syndrome. Experience with an operation to establish functionally normal circulation. J Thorac Cardiovasc Surg 1977;74:624-30.
4. Norwood WI, Lang P, Hansen DD. Physiologic repair of aortic atresiahypoplastic left heart syndrome. N Engl J Med 1983;308:23-6.
5. Malik S, Cleves MA, Zhao W, Correa A, Hobbs CA. Association between congenital heart defects and small for gestational age. Pediatrics 2007;119:e976-e982.
6. Rosenthal GL. Patterns of prenatal growth among infants with cardiovascular malformations: possible fetal hemodynamic effects. Am J Epidemiol 1996;143:505-13.
7. Rosenthal GL, Wilson PD, Permutt T, Boughman JA, Ferencz C. Birth weight and cardiovascular malformations: a population-based study. The Baltimore-Washington Infant Study. Am J Epidemiol 1991;133:1273-81.
8. Tanner K, Sabrine N, Wren C. Cardiovascular malformations among preterm infants. Pediatrics 2005;116:e833-e838.
9. Grantham-McGregor SM. Small for gestational age, term babies, in the first six years of life. Eur J Clin Nutr 1998;52(Suppl 1):S59-S64.
10. Morley R, Fewtrell MS, Abbott RA, Stephenson T, MacFadyen U, Lucas A. Neurodevelopment in children born small for gestational age: a randomized trial of nutrient-enriched versus standard formula and comparison with a reference breastfed group. Pediatrics 2004;113:515-21.
11. Curzon CL, Milford-Beland S, Li JS, O’Brien SM, Jacobs JP, Jacobs ML, et al. Cardiac surgery in infants with low birth weight is associated with increased mortality: analysis of the Society of Thoracic Surgeons Congenital Heart Database. J Thorac Cardiovasc Surg 2008;135:546-51.
12. Oppido G, Napoleone CP, Formigari R, Gabbieri D, Pacini D, Frascaroli FG, et al. Outcome of cardiac surgery in low birth weight and premature infants. Eur J Cardiothorac Surg 2004;26:44-53.
13. Ghanayem NS, Hoffman GM, Mussatto KA, Frommelt MA, Cava JR, Mitchell ME, et al. Perioperative monitoring in high-risk infants after stage 1 palliation of univentricular congenital heart disease. J Thorac Cardiovasc Surg 2010;140:857-63.
14. Costello JM, Pasquali SK, Jacobs JP, He X, Hill KD, Cooper DS, et al. Gestational age at birth and outcomes after neonatal cardiac surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Circulation 2014;129:2511-7.
15. O’Reilly M, Sozo F, Harding R. Impact of preterm birth and bronchopulmonary dysplasia on the developing lung: long-term consequences for respiratory health. Clin Exp Pharmacol Physiol 2013;40:765-73.
16. McMahon CJ, Penny DJ, Nelson DP, Ades AM, Maskary SA, Speer M, et al. Preterm infants with congenital heart disease and bronchopulmonary dysplasia: postoperative course and outcome after cardiac surgery. Pediatrics 2005;116:423-30.
17. Hickey EJ, Nosikova Y, Zhang H, Caldarone CA, Benson L, Redington A, et al. Very low-birth-weight infants with congenital cardiac lesions: is there merit in delaying intervention to permit growth and maturation? J Thorac Cardiovasc Surg 2012;143:126-36.
18. Sahni R, Polin RA. Physiologic underpinnings for clinical problems in moderately preterm and late preterm infants. Clin Perinatol 2013;40:645-63.
19. Alsoufi B, Gillespie S, Kogon B, Schlosser B, Sachdeva R, Kim D, et al. Results of palliation with an initial modified Blalock Taussig shunt in neonates with single ventricle anomalies associated with restrictive pulmonary blood flow. Ann Thorac Surg 2015;99:1639-46.
20. Baba K, Kotani Y, Chetan D, Chaturvedi RR, Lee KJ, Benson NL, et al. Hybrid versus Norwood strategies for single-ventricle palliation. Circulation 2012;126(11 Suppl 1):S123-31.
21. Mascio CE, Irons ML, Ittenbach RF, Gaynor JW, Fuller SM, Kaplinski M, et al. Thirty years and 1663 consecutive Norwood procedures: Has survival plateaued? J Thorac Cardiovasc Surg 2019;158:220-9.
22. Sano S, Huang SC, Kasahara S, Yoshizumi K, Kotani Y, Ishino K. Risk factors for mortality after the Norwood procedure using right ventricle to pulmonary artery shunt. Ann Thorac Surg 2009;87:178-85; discussion 185-6.
23. Wilder TJ, McCrindle BW, Hickey EJ, Ziemer G, Tchervenkov CI, Jacobs ML, et al. Is a hybrid strategy a lower-risk alternative to stage 1 Norwood operation? J Thorac Cardiovasc Surg 2017;153:163-72.e6.
24. Oppido G, Napoleone CP, Formigari R, Gabbieri D, Pacini D, Frascaroli G, et al. Outcome of cardiac surgery in low birth weight and premature infants. Eur J Cardiothorac Surg 2004;26:44-53.
25. Kussman BD, Gauvreau K, DiNardo JA, Newburger JW, Mackie AS, Booth KL, et al. Cerebral perfusion and oxygenation after the Norwood procedure: comparison of right ventricle-pulmonary artery conduit with modified Blalock-Taussig shunt. J Thorac Cardiovasc Surg 2007;133:648-55.
26. Yıldırım Ö, Bakhshaliyev S, Kilercik H, Balaban İ, Zübarioğlu U, Konukoğlu O, et al. Early results of ring-reinforced conduit and curved porcine patch in Sano-Norwood procedure. J Card Surg 2019;34:279-84.
27. Bove T, Francois K, De Groote K, Suys B, De Wolf D, Verhaaren H, et al. Outcome analysis of major cardiac operations in low weight neonates. Ann Thorac Surg 2004;78:181-7.
28. Rollins CK, Newburger JW, Roberts AE. Genetic contribution to neurodevelopmental outcomes in congenital heart disease: are some patients predetermined to have developmental delay? Curr Opin Pediatr 2017;29:529-33 .
29. Russell MW, Chung WK, Kaltman JR, Miller TA. Advances in the understanding of the genetic determinants of congenital heart disease and their impact on clinical outcomes. J Am Heart Assoc 2018;7:e006906 .
30. Prior T, Wild M, Mullins E, Bennett P, Kumar S. Sex specific differences in fetal middle cerebral artery and umbilical venous Doppler. PLoS One 2013;8(2):e56933.

ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi