LAUSR

We developed a technique for the Norwood operation utilizing continuous perfusion of the head, heart, and lower body at mild hypothermia named Sustained Total All-Region (STAR) perfusion. We hypothesized that STAR perfusion would be associated with shorter operative times, decreased coagulopathy, and expedited post-operative recovery compared to standard perfusion techniques. Between 2012-2020, 80 infants underwent primary Norwood reconstruction at our institution. Outcomes for patients who received successful STAR perfusion (STAR, n=37) were compared to those who received standard Norwood reconstruction utilizing regional cerebral perfusion only (SNR, n=33), as well as to Norwood patients reported in the PC4 national database during the same timeframe (n=1238). STAR perfusion was performed with cannulation of the innominate artery, descending aorta, and aortic root at 32-34°C. STAR patients had shorter median CPB time compared to SNR (171 vs. 245 mins, p<0.0001), shorter operative time (331 vs. 502 mins, p<0.0001), and decreased intraoperative pRBC transfusion (100 vs. 270 mL, p<0.0001). STAR patients had decreased vasoactive-inotropic score on ICU admission (6 vs. 10.8, p=0.0007) and decreased time to chest closure (2 vs. 4.5 days, p=0.0004). STAR patients had lower peak lactate (8.1 vs. 9.9 mmol/L, p=0.03) and more rapid lactate normalization (18.3 vs. 27.0 hours, p=0.003). In-hospital mortality in STAR patients was 2.7% vs. 15.1% with SNR (p=0.06) and 10.3% in the PC4 aggregate (p=0.14). STAR perfusion is a novel approach to Norwood reconstruction that was associated with excellent survival, decreased transfusions, shorter operative time, and improved convalescence in the early post-operative period.