{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:50:58Z","timestamp":1790704258934,"version":"4.1.0"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,4,1]],"date-time":"2020-04-01T00:00:00Z","timestamp":1585699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>The interstage mortality rate after a Norwood stage 1 operation remains 12\u201320% in current series. In-hospital interstage facilitates escalation of care, possibly improving outcome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>A retrospective study was designed for hypoplastic left heart syndrome (HLHS) and HLHS variants, offering an in-hospital stay after the Norwood operation until the completion of stage 2. Daily and weekly examinations were conducted systematically, including two-dimensional and speckle-tracking echocardiography. Primary end points included aggregate survival until the completion of stage 2 and interstage freedom from escalation of care. Moreover, we calculated the sensitivity and specificity of speckle-tracking echocardiographic myocardial deformation in predicting death\/transplant after the Norwood procedure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Between 2015 and 2019, 33 neonates with HLHS (24) or HLHS variants (9) underwent Norwood stage 1 (31) or hybrid palliation followed by a comprehensive stage 2 operation (2). Stage 1 Norwood\u2013Sano was preferred in 18 (54.5%) neonates; the classic Norwood with Blalock\u2013Taussig shunt was performed in 13 (39.4%) neonates. The Norwood stage 1 30-day mortality rate was 6.2%. The in-hospital interstage strategy was implemented after Norwood stage 1 with a 3.4% interstage mortality rate. The aggregate Norwood stage 1 and interstage Kaplan\u2013Meier survival rate was 90.6\u2009\u00b1\u20095.2%. Escalation of care was necessary for 5 (17.2%) patients at 2.5\u2009\u00b1\u20091.2\u2009months during the interstage for compromising atrial arrhythmias (2), Sano-shunt stenosis (1) and pneumonia requiring a high-frequency oscillator (2); there were no deaths. A bidirectional Glenn (25) or a comprehensive-Norwood stage 2 (2) was completed in 27 patients at 4.7\u2009\u00b1\u20091.2\u2009months with a 92.6% survival rate. The overall Kaplan\u2013Meier survival rate is 80.9\u2009\u00b1\u20097.0% at 4.3\u2009years (mean 25.3\u2009\u00b1\u200915.7\u2009months). An 8.7% \u0394 longitudinal strain 30\u2009days after Norwood stage 1 had 100% sensitivity and 81% specificity for death\/transplant.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>In-hospital interstage facilitates escalation of care, which seems efficacious in reducing interstage Norwood deaths. A significant reduction of longitudinal strain after Norwood stage 1 is a strong predictor of poor outcome.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaa074","type":"journal-article","created":{"date-parts":[[2020,2,16]],"date-time":"2020-02-16T04:29:37Z","timestamp":1581827377000},"page":"1113-1121","source":"Crossref","is-referenced-by-count":18,"title":["In-hospital interstage improves interstage survival after the Norwood stage 1 operation"],"prefix":"10.1093","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3771-8967","authenticated-orcid":false,"given":"Guido","family":"Michielon","sequence":"first","affiliation":[{"name":"Department of Congenital Heart Surgery, Royal Brompton Hospital, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0305-0113","authenticated-orcid":false,"given":"Giovanni","family":"DiSalvo","sequence":"first","affiliation":[{"name":"Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Fraisse","sequence":"first","affiliation":[{"name":"Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julene S","family":"Carvalho","sequence":"first","affiliation":[{"name":"Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Krupickova","sequence":"first","affiliation":[{"name":"Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zdenek","family":"Slavik","sequence":"first","affiliation":[{"name":"Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4599-2002","authenticated-orcid":false,"given":"Margarita","family":"Bartsota","sequence":"first","affiliation":[{"name":"Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierce","family":"Daubeney","sequence":"first","affiliation":[{"name":"Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4946-9219","authenticated-orcid":false,"given":"Carles","family":"Bautista","sequence":"first","affiliation":[{"name":"Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, 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