OBJECTIVE: Optimisation of Norwood physiology, with focus on systemic perfusion, has beneficial effects on haemodynamic stability and perioperative mortality following the Norwood procedure for @entity1699 . Early identification of high-risk @entity1 during the postoperative phase might allow for institution of alternative management strategies with the possibility of avoiding poor outcome. Several studies have suggested that arterial blood @entity880 level, as an index of systemic perfusion and @entity26 delivery, can to some extent predict mortality following paediatric cardiac surgery, though these studies have included heterogeneous groups of @entity1 with only few Norwood @entity1 . We sought to determine whether the blood @entity880 profile could be used to derive a simple, clinically applicable decision algorithm to direct therapy in a pre-emptive manner and perhaps identify @entity1 for elective extracorporeal life support following the Norwood procedure. METHODS: We retrospectively analysed all @entity1 at our institution who had undergone modified Norwood procedures between March 2002 and May 2008. All @entity1 had received right ventricle-pulmonary artery conduits. @entity1 with systemic-pulmonary shunts were excluded. Outcome measures included 7-day and 30-day mortality. Serial arterial blood @entity880 measurements were taken in all @entity1 for at least 72h. Conditional inference tree modelling was used to determine the discriminatory value of the @entity880 profile and other pre- and intra-operative risk factors in terms of selecting survivors. RESULTS: As many as 221 @entity1 were included. The 7-day ICU mortality was 26/219 (11.8%) with total 30-day mortality of 35/219 (15.8%). There were 21 interstage deaths. Mortality modelling demonstrated that an inability to clear blood @entity880 levels to <6.76mmoll(-1) within the first 24h was highly discriminatory in terms of predicting @entity204 within the first 30 days. A total of 11 out of 12 @entity1 in this group died. Other risk factors examined, including weight, ascending aorta size, cardiopulmonary bypass and ischaemic times, were not as predictive in our model. CONCLUSION: We have identified minimum blood @entity880 level within the first 24h after the Sano-Norwood procedure as a highly discriminatory predictor of perioperative mortality. These @entity1 might benefit from elective institution of early mechanical circulatory support.

The importance of blood XXXX clearance as a predictor of early mortality following the modified Norwood procedure.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity1699 :: ('MESH:D018636', 'Disease') :: ['hypoplastic left heart syndrome'] @entity26 :: ('MESH:D010100', 'Chemical') :: ['oxygen'] @entity880 :: ('MESH:D019344', 'Chemical') :: ['lactate'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death']
@entity880 :: (MESH:D019344,Chemical) :: ['lactate']
