In the early 1990's, babies born with the HLHS defect had very little hope of survival. At the Medical College of Wisconsin and Children's Hospital of Wisconsin, the early survival rate following the first and most complex of the three surgeries required to correct the defect is now better than 97 percent, the best currently reported in the world.
The Norwood Procedure, normally done shortly after birth, is the first and most complex step toward converting the right ventricle into the main pump to the body and redirecting blood flow to the lungs and body.
"We continue to study the best treatment options to improve long-term outcomes and minimize developmental delay and learning disabilities,” says James Tweddell, M.D, professor of surgery and pediatrics, and chief of the division of cardiothoracic surgery at the Medical College.
The Milwaukee team continues to analyse outcomes using a prospective patient database that currently holds data on over 150 children to help identify risk factors and results of new treatment strategies. These combination factors include oxygen level monitoring during and after the first surgery, new anaesthesiology and perfusion techniques, and perioperative drug therapies such as phenoxybenzamine.
The aggressive home monitoring program allowed them to take corrective action early. This technique has improved survival to nearly 100 percent with home monitoring and better identifies timing for the second stage operation based on growth and oxygen levels.
The cardiac anaesthesia and critical care teams are leading a study using near infrared spectroscopy to allow non-invasive assessment of brain oxygen metabolism. "We perfuse the brain with oxygen during the entire surgical procedure to get better long term neurological function. In addition, we found a clear, immediate impact on survival rate after surgery,” says Dr. Tweddell.
MEDICA.de; Source: Medical College of Wisconsin