Interdigitating arch reconstruction eliminates recurrent coarctation after the Norwood procedure. J Thorac Cardiovasc Surg 2005 Jul;130(1):61-5
Date
07/07/2005Pubmed ID
15999042DOI
10.1016/j.jtcvs.2005.02.060Scopus ID
2-s2.0-21744453961 (requires institutional sign-in at Scopus site) 84 CitationsAbstract
BACKGROUND: We sought to determine whether evolving techniques of aortic arch reconstruction used during the Norwood procedure decreased the incidence of postoperative aortic arch obstruction.
METHODS: Our technique for aortic arch reconstruction in patients undergoing the Norwood procedure has evolved from using an allograft patch (classic group, n = 26) to primary connection of the pulmonary artery and arch (autologous group, n = 20). More recently, we have used a novel technique involving coarctation excision, an extended end-to-end anastomosis on the back of the arch, and a counterincision on the anterior descending aorta to sew in an allograft patch for total arch reconstruction (interdigitating group, n = 33). Cardiac catheterizations performed before stage II palliation were reviewed for aortic diameters at multiple levels in 79 infants (median age, 4.2 months). Aortic arch obstruction was defined as a ratio between the diameters of the arch anastomosis and the descending aorta (coarctation index) of less than 0.7.
RESULTS: Overall, 15 (19%) children had aortic arch obstruction. All 15 required aortic intervention (balloon angioplasty, n = 12; surgical patch angioplasty, n = 2; both, n = 1). Aortic arch obstruction rates for the classic, autologous, and interdigitating groups were 46% (n = 12), 15% (n = 3), and 0%, respectively ( P > .001).
CONCLUSION: Reconstruction of the aortic arch with excision of ductal and coarctation tissue is associated with lower aortic arch obstruction rates in patients undergoing the Norwood procedure. Arch reconstruction with a novel interdigitating technique decreases the incidence of aortic arch obstruction.
Author List
Burkhart HM, Ashburn DA, Konstantinov IE, De Oliveira NC, Benson L, Williams WG, Van Arsdell GSAuthor
Nilto De Oliveira MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Angioplasty, BalloonAorta, Thoracic
Aortic Coarctation
Cardiac Catheterization
Cardiac Surgical Procedures
Child, Preschool
Female
Humans
Infant
Male
Recurrence