{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:18:47Z","timestamp":1788499127364,"version":"build-2803163510"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The delayed Norwood (DN) approach, preceded by bilateral pulmonary artery banding (bPAB), has emerged as a strategy to improve outcomes in high-risk infants by addressing neonatal haemodynamic instability and organ immaturity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-centre, retrospective study analysed 20 consecutive patients with hypoplastic left heart syndrome\/variants and multiple risk factors who underwent a DN operation following bPAB between 2019 and 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Bilateral pulmonary artery banding was performed at a median age of 2.5 days (interquartile range [IQR]: 2-4). Preoperative risk factors included prematurity (35%), low birth weight &amp;lt;2.5 kg (25%), non-cardiac comorbidities (25%), genetic syndromes (50%), preoperative cardiogenic shock (35%), and restrictive atrial septum (25%). The median age at DN was 36 days (IQR: 29-79), with an operative survival rate of 75%. Patients who underwent the DN within 4 weeks of bPAB did not require any pulmonary artery (PA) reinterventions. Median lactate clearance time was 8 hours (IQR: 5-18), and the median vasoactive inotropic score decreased by 47% within 48 hours postoperatively. Cerebral near-infrared spectroscopy values improved in patients without postoperative extracorporeal membrane oxygenation (ECMO) support from 53% to 58% and 63% at 0, 12, and 36 hours, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The DN approach, preceded by initial bPAB in a high-risk patient cohort, achieved surgical outcomes comparable to those of lower-risk patients undergoing primary Norwood operation. A DN procedure around 4-6 weeks of following bPAB may improve survival rates in high-risk patients with a reduction in surgical or catheter-based reinterventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/icvts\/ivag218","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T14:19:41Z","timestamp":1787926781000},"source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of Delayed Norwood Operation in High-Risk Patients\u2014Time to Reconsider the Dogma of a Primary Norwood Operation?"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7841-1745","authenticated-orcid":false,"given":"Mahmut","family":"Ozturk","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Children\u2019s National Hospital, The George Washington University School of Medicine and Health Sciences , Washington, DC 20010,","place":["United 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Cardiology, Children\u2019s National Hospital, The George Washington University School of Medicine and Health Sciences , Washington, DC 20010,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Gordish-Dressman","sequence":"additional","affiliation":[{"name":"Research Center for Genetic Medicine, Children\u2019s National Hospital , Washington, DC,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen Kalinger","family":"Reid","sequence":"additional","affiliation":[{"name":"Department of Cardiac Critical Care Medicine, Children\u2019s National Hospital, The George Washington University School of Medicine and Health Sciences , Washington, DC 20010,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo Alfonso","family":"Munoz","sequence":"additional","affiliation":[{"name":"Department of Cardiac Critical Care Medicine, Children\u2019s 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