SINGLE-CENTER EXPERIENCE OF NORWOOD PROCEDURE FOR HYPOPLASTIC LEFT HEART SYNDROME: BLALOCK-TAUSSIG SHUNT OR RIGHT VENTRICLE–PULMONARY ARTERY CONDUIT?

Background and Aim: Norwood procedure is used as first stage palliation in hypoplastic left heart syndrome (HLHS) or other single-ventricle lesions with systemic outflow obstruction. Evolution of this technique was focused to define the source of pulmonary blood supply. Aim of this study was to compare early and late results of Norwood using either Blalock- Taussig (BT) shunt or a right ventricle–pulmonary artery (RV-PA) conduit. Methods: A retrospective review of 76 patients, who underwent Norwood procedure from February 2013 to July 2024 at Bambino Gesù Children’s Hospital, was done. 24 infants received a RV-PA conduit while in 43 a BT shunt was used. 9 patients, who underwent Comprehensive Norwood after hybrid approach, were excluded. We assessed difference in surgical operative time, in-hospital mortality rates and progression to later stages of palliation. Results: No significant differences between two groups in mortality, hospitalization, or surgical operative time occurred. In BT group, 32 patients underwent subsequently Glenn procedure (in 11 associated to pulmonary artery enlargement and in 2 with tricuspid valve repair) and 17 advanced to Fontan palliation; in this group 3 underwent heart transplants. In RV-PA conduit group, 15 patients underwent Glenn procedure (associated in 3 to pulmonary artery plasty and in 7 to tricuspid valve repair) and 1 progressed to Fontan palliation. None needed heart transplant. Conclusions: There is no clear advantage of one approach over the other based on our result. Further research is needed, as Sano technique was introduced at our Center more recently compared to traditional BT shunt.