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Coarctectomy combined with an interdigitating arch reconstruction results in a lower incidence of recurrent arch obstruction after the Norwood procedure than coarctectomy alone. J Thorac Cardiovasc Surg 2012 May;143(5):1098-102



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Pubmed Central ID




Scopus ID

2-s2.0-84859757034   28 Citations


OBJECTIVE: Recurrent aortic arch obstruction after the Norwood procedure continues to be a source of morbidity. We sought to determine if a modified interdigitating technique for aortic arch reconstruction during the Norwood procedure decreased recurrent arch obstruction.

METHODS: A total of 142 consecutive infants undergoing the Norwood procedure were divided into groups according to surgical technique: Group 1 (n = 79, January 1999 to May 2003) underwent arch reconstruction with complete coarctectomy followed by anastomosis of the descending aorta to the transverse arch. Group 2 (n = 63, June 2003 to September 2006) underwent complete coarctectomy plus a modified interdigitating technique. Catheterization before stage 2 palliation was reviewed for hemodynamics and angiographic arch dimensions, and a coarctation index was calculated.

RESULTS: Reintervention for recurrent coarctation occurred in 28% (22/79) of group 1 patients compared with 2% (1/63) of group 2 patients (P = .001). Aortic pressures, gradients, dimensions, and coarctation index were consistently more favorable for group 2.

CONCLUSIONS: Coarctectomy plus an interdigitating arch anastomosis was superior to coarctectomy alone and resulted in a dramatically decreased incidence of recurrent arch obstruction.

Author List

Lamers LJ, Frommelt PC, Mussatto KA, Jaquiss RD, Mitchell ME, Tweddell JS


Peter C. Frommelt MD Professor in the Pediatrics department at Medical College of Wisconsin
Michael Edward Mitchell MD Professor in the Surgery department at Medical College of Wisconsin
Kathleen Mussatto in the CTSI department at Medical College of Wisconsin - CTSI

MESH terms used to index this publication - Major topics in bold

Anastomosis, Surgical
Aorta, Thoracic
Aortic Coarctation
Chi-Square Distribution
Infant, Newborn
Norwood Procedures
Palliative Care
Retrospective Studies
Treatment Outcome
Vascular Surgical Procedures
jenkins-FCD Prod-467 7c8a156729bba74d775d9c546792cde315827259