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Single-center experience of arch reconstruction in the setting of Norwood operation.

Abstract

BACKGROUND
Arch reconstruction is a key part of the Norwood operation for hypoplastic left heart syndrome and is related to late morbidity. Since 2003, our surgical technique has been standardized to a right ventricle to pulmonary artery conduit, arch reconstruction with homograft patch, and Damus-Kaye-Stansel anastomosis onto homograft patch, with partial or complete resection of any coarctation ridge. We studied the impact of the surgical approach on arch reinterventions and outcome.
METHODS
A retrospective review of echocardiogram, catheterizations, and hospital records of patients who underwent stage1 reconstruction from January 2003 to December 2010 was performed.
RESULTS
A total of 289 patients underwent stage 1 reconstruction during this period. Age and body weight at operation were 9.3 ± 25 days and 3.1 ± 0.6 kg. Early survival was 86%. Seventy-three patients (25%) underwent intervention for recoarctation: balloon angioplasty (n = 68) or surgical intervention (n = 11). Eighteen patients underwent multiple interventions for recoarctation. Size of ascending aorta and incomplete resection of ductal tissue were risk factors for reintervention (p = 0.01 and p = 0.02). Patients with an ascending aorta diameter less than 2 mm had significantly higher reintervention rates (p = 0.01).
CONCLUSIONS
Our standard technique for the Norwood operation has good results but further intervention for recoarctation is common. Size of ascending aorta and incomplete resection of coarctation tissue were risk factors for recoarctation. Complete resection of coarctation tissue may reduce the incidence of recoarctation. A small ascending aorta may predict late arch problems.

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    • Authors

    Sakurai T, Rogers V, Stickley J, Khan N, Jones TJ, Barron DJ, Brawn WJ

    Institution

    Department of Cardiac Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom.

    Source

    The Annals of thoracic surgery 94:5 2012 Nov pg 1534-9

    MeSH

    Aorta, Thoracic
    Female
    Humans
    Hypoplastic Left Heart Syndrome
    Infant, Newborn
    Male
    Norwood Procedures
    Recurrence
    Retrospective Studies

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22841016