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Stage I palliation for hypoplastic left heart syndrome: Norwood versus Sano modification

Reemtsen, Brian La,b; Pike, Nancy Ab; Starnes, Vaughn Aa,b

Current Opinion in Cardiology: March 2007 - Volume 22 - Issue 2 - p 60–65
doi: 10.1097/HCO.0b013e328014da09

Purpose of review Advancements in surgical technique and perioperative care have significantly improved the survival of infants born with hypoplastic left heart syndrome. A recent modification to the Norwood procedure is being adopted by many centers to improve postoperative hemodynamic stability and survival to stage II palliation. The late effects of this modification, however, are speculated and have not been investigated.

Recent findings Center-specific improved short-term outcomes have been reported in a few small, nonrandomized studies of a new approach to the Norwood procedure, which utilizes a right ventricle to pulmonary artery shunt or Sano modification to provide pulmonary blood flow rather than the standard modified Blalock-Taussig shunt.

Summary The classic Norwood procedure and Sano modification each have specific advantages and disadvantages in both the short and long term. Data comparing the two techniques are nonrandomized, contradictory, and utilize historical controls. The optimal shunt to improve survival to the second-stage palliation is unknown. A multicenter randomized clinical trial comparing the Sano with the modified Blalock-Taussig shunt in hypoplastic left heart syndrome or variants is currently in progress and should hopefully provide future guidelines for shunt selection based on clinical presentation.

aKeck School of Medicine, University of Southern California, Los Angeles, California, USA

bDivision of Cardiothoracic Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA

Correspondence to Brian L. Reemtsen MD, Division of Cardiothoracic Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS # 66, Los Angeles, CA 90027, USA Tel: +1 323 669 4148; fax: +1 323 913 2865; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.