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Post-Operative Recovery Following Norwood Palliation After Internal Flow Restrictor Placement Versus Early Norwood: A Case-Control Study
Lindsey M. Reynolds1, Seth E.M. Wolf, MD2, Rebekah R. Boyd, MD2, Haoran Jiang, MS1, Natasha Anders, BS1, Neel K. Prabhu, MD2, Cathlyn K. Medina, MD2, Emily L. Larson, MD2, Kevin D. Hill, MD3, Joseph W. Turek, MD, PhD, MBA2, Douglas M. Overbey, MD, MPH2.
1Duke University School of Medicine, Durham, NC, USA, 2Department of Surgery, Duke University Medical Center, Durham, NC, USA, 3Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA.
ObjectivesInternal flow restrictors (IFRs) have emerged as a transcatheter strategy to modulate pulmonary flow and permit delayed Norwood palliation in neonates with single ventricle physiology. The impact of IFR-mediated stabilization on post-operative recovery compared with early Norwood palliation remains unclear.
MethodsWe performed a retrospective case-control study comparing patients undergoing delayed Norwood following IFR placement with those undergoing early Norwood. Continuous variables were compared using Mann-Whitney U and categorical variables using Fisher’s exact testing. The primary outcome was hypoxemia. Secondary outcomes included time to extubation, vasoactive duration, lactate kinetics, ICU and hospital length of stay (LOS), and post-operative complications.
ResultsIFR patients underwent Norwood at an older age (21.5 vs 5.0 days, p<0.001) following a 15-day interval from IFR placement to surgery despite similar operative weight (3.4 vs 3.4 kg, p=0.97). IFR patients more frequently required pre-operative vasoactive support (64% vs 27%, p=0.03) and intubation (73% vs 45%, p=0.12). Pre-operative peak lactate was lower in the IFR cohort (1.0 vs 1.5 mmol/L, p=0.006). Post-operative hypoxemia occurred less frequently following IFR-mediated delayed Norwood (9% vs 55%, p=0.003). Time to extubation was comparable (7.0 vs 7.0 days, p=0.20). IFR patients demonstrated faster lactate normalization (9.0 vs 28.8 hours, p<0.001). ICU and hospital LOS were similar.
ConclusionsDelayed Norwood after IFR placement was associated with improved metabolic stabilization and fewer hypoxemic events despite greater illness severity, with otherwise comparable recovery.
recovery.
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