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J Thorac Cardiovasc Surg. 2005 Jul;130(1):61-5.

Interdigitating arch reconstruction eliminates recurrent coarctation after the Norwood procedure.

Author information

  • 1Department of Cardiothoracic Surgery, Universaity of Iowa Hospital and Clinics, 200 Hawlins Drive, Iowa City, IA 52242, USA. harold-burkhart@uiowa.edu

Erratum in

  • J Thorac Cardiovasc Surg. 2005 Oct;130(4):1195. De Oliviera, Nilto C [corrected to De Oliveira, Nilto C].

Abstract

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.

PMID:
15999042
[PubMed - indexed for MEDLINE]
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