{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T20:54:44Z","timestamp":1760648084894,"version":"build-2065373602"},"reference-count":15,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,10,18]],"date-time":"2024-10-18T00:00:00Z","timestamp":1729209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: A Norwood procedure performed after 14 days of life is notably burdened by a high mortality. We analysed the real risk and which other factors influence the mortality in late Norwood procedures. Methods: A single-centre, retrospective review of a series of consecutive patients who underwent a surgical Norwood procedure from January 2019 until December 2023. The patients\u2019 characteristics were considered to identify the factors associated with in-hospital and interstage mortality. Results: 35 patients were included and 71% (25) of the patients underwent the Norwood procedure after 14 days of life. The median age was 27 days (6\u2013259 days). The in-hospital mortality was 26% (9\/35) with 89% (8) of the deceased being older than 15 days at the time of the surgery. Other factors that negatively affected the outcome were a restrictive interatrial septum defect (ASD) in 66% of all patients (23), the need for mechanical ventilation in 46% (16) and systemic infection prior to surgery in 43% (15). Conclusions: Age at the time of Norwood was not associated with a higher risk of mortality, but other factors such as restrictive ASD, preoperative infection and the need for mechanical ventilation prior to surgery are even more important in predicting the short-term outcome.<\/jats:p>","DOI":"10.3390\/children11101262","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T03:57:09Z","timestamp":1729483029000},"page":"1262","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["In-Hospital and Interstage Mortality After Late Norwood Procedure: Acknowledging the Risks When We Are Running Out of Time"],"prefix":"10.3390","volume":"11","author":[{"given":"Andreea Alina","family":"Andronache","sequence":"first","affiliation":[{"name":"Pediatric and Congenital Heart Disease Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Di Cosola","sequence":"additional","affiliation":[{"name":"Pediatric and Congenital Heart Disease Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Evangelista","sequence":"additional","affiliation":[{"name":"Pediatric and Congenital Heart Disease Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3144-9364","authenticated-orcid":false,"given":"Sara","family":"Boveri","sequence":"additional","affiliation":[{"name":"Scientific Division, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Schianchi","sequence":"additional","affiliation":[{"name":"Scientific Division, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Giamberti","sequence":"additional","affiliation":[{"name":"Pediatric and Congenital Heart Disease Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo","family":"Chessa","sequence":"additional","affiliation":[{"name":"Pediatric and Congenital Heart Disease Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"},{"name":"Medical School, Vita-Salute San Raffaele University, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.jtcvs.2012.05.020","article-title":"Interstage mortality after the Norwood procedure: Results of the multicenter Single Ventricle Reconstruction trial","volume":"144","author":"Ghanayem","year":"2012","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1093\/ejcts\/ezaa188","article-title":"Guidelines for the management of neonates and infants with hypoplastic left heart syndrome: The European Association for Cardio-Thoracic Surgery (EACTS) and the Association for European Paediatric and Congenital Cardiology (AEPC) Hypoplastic Left Heart Syndrome Guidelines Task Force","volume":"58","author":"Alphonso","year":"2020","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1016\/j.jtcvs.2012.05.019","article-title":"Risk factors for hospital morbidity and mortality after the Norwood procedure: A report from the Pediatric Heart Network Single Ventricle Reconstruction trial","volume":"144","author":"Tabbutt","year":"2012","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Sames-Dolzer, E., Hakami, L., Innerhuber, M., Tulzer, G., and Mair, R. (2015). Older age at the time of the Norwood procedure is a risk factor for early postoperative mortality. Eur. J. Cardio-Thorac. Surg., 47.","DOI":"10.1093\/ejcts\/ezu128"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Sano, S., Huang, S.-C., Kasahara, S., Yoshizumi, K., Kotani, Y., and Ishino, K. (2009). Risk factors for mortality after the Norwood procedure using right ventricle to pulmonary artery shunt. Ann. Thorac. Surg., 87.","DOI":"10.1016\/j.athoracsur.2008.08.027"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1016\/j.athoracsur.2018.01.001","article-title":"The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2018 Update on Outcomes and Quality. 2018, 105, 680\u2013690","volume":"105","author":"Jacobs","year":"2018","journal-title":"Ann. Thorac. 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Surg."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Jacobs, J.P., O\u2019Brien, S.M., Chai, P.J., Morell, V.O., Lindberg, H.L., and Quintessenza, J.A. (2008). Management of 239 patients with hypoplastic left heart syndrome and related malformations from 1993 to 2007. Ann. Thorac. Surg., 85.","DOI":"10.1016\/j.athoracsur.2008.01.057"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.jacc.2011.09.022","article-title":"Hypoplastic left heart syndrome: Current considerations and expectations","volume":"59","author":"Feinstein","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"E848","DOI":"10.1097\/PCC.0000000000002478","article-title":"Standardization of the Perioperative Management for Neonates Undergoing the Norwood Operation for Hypoplastic Left Heart Syndrome and Related Heart Defects","volume":"21","author":"Natarajan","year":"2020","journal-title":"Pediatr. Crit. Care Med."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/10\/1262\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:16:26Z","timestamp":1760112986000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/10\/1262"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,18]]},"references-count":15,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["children11101262"],"URL":"https:\/\/doi.org\/10.3390\/children11101262","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2024,10,18]]}}}