This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Reinhartz, O. Articles by Hanley, F. L. Search for Related Content PubMed PubMed Citation Articles by Reinhartz, O. Articles by Hanley, F. L. Related Collections Pediatric and congenital heart disease, including cardiovascular surgery

(Circulation. 2006;114:I-594 – I-599.)
© 2006 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Homograft Valved Right Ventricle to Pulmonary Artery Conduit as a Modification of the Norwood Procedure

Olaf Reinhartz, MD; V. Mohan Reddy, MD; Edwin Petrossian, MD; Malcolm MacDonald, MD; John J. Lamberti, MD; Stephen J. Roth, MD, MPH; Gail E. Wright, MD; Stanton B. Perry, MD; Sam Suleman, BS; Frank L. Hanley, MD

From the Divisions of Pediatric Cardiothoracic Surgery and Pediatric Cardiology, Stanford University School of Medicine, Stanford, Calif.

Correspondence to Olaf Reinhartz, Cardiothoracic Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305. E-mail orx{at}stanford.edu

Background— The use of a right ventricle to pulmonary artery (RV-PA) conduit in the Norwood procedure has been proposed to increase postoperative hemodynamic stability. A valve within the conduit should further decrease RV volume load. We report our clinical experience with this modification.

Methods and Results— From February 2002 through August 2005, we performed 88 consecutive Norwood procedures using RV-PA conduits. We used composite valved conduits made from cryopreserved homograft and polytetrafluoroethylene (PTFE) in 66 cases (54 pulmonary, 12 aortic homografts), other valved conduits in 14, and unvalved PTFE in 8 cases. Hospital survival was 88.6% overall and increased to 93.1% after the initial year. Early interventions were required in 18 patients (16 for cyanosis). Prestage II cardiac catheterization was performed at a mean age of 126 days. Mean Qp/Qs was 1, with mean aortic saturation 71%, mean O₂ extraction 24%, and mean right ventricular end-diastolic pressure 9 mm Hg. Patient weight, use of an aortic homograft valve in the conduit, stage I palliation within the first year of our experience, and low O₂ extraction and high transpulmonary gradient prestage II were risk factors for overall death. Early interventions were more frequent in aortic valve conduits compared with all other conduits.

Conclusions— The valved RV-PA conduit was associated with low early mortality after the Norwood procedure. The majority of these patients had normal cardiac output and well-maintained RV function. There may be a higher risk for early conduit interventions and death when aortic valve homografts are used in the RV-PA conduit.

Key Words: congenital • heart defects • surgery • survival