Abstract 2351: Decreased Incidence of Recurrent Coarctation of the Aorta Following the Norwood Procedure
Background: Recurrent aortic arch obstruction following the Norwood procedure (NP) causes significant morbidity. A interdigitating technique during the NP arch reconstruction has been adopted at the Children’s Hospital of Wisconsin.
Methods: 142 consecutive infants undergoing the NP were divided into 2 groups based upon surgical technique: Group 1(n=53) underwent arch reconstruction with complete coarctectomy followed by anastomosis of the descending aorta to the transverse arch (1999 –2001), Group 2(n=89) underwent a interdigitating technique with complete coarctectomy followed by counterincision into the posterior left lateral descending thoracic aorta prior to extended end-to-end anastomosis of the transverse arch and the descending aorta with pulmonary homograft augmentation (2002–2006). Cardiac catheterization prior to Stage 2 palliation was reviewed for hemodynamics and angiographic arch dimensions. Coarctation index (CI) was calculated (distal arch anastomosis/aortic dimensions at the diaphragm).
Results: Aortic pressures, gradients, dimensions, CI and recoarctation rate were significantly different between groups (Table⇓). Breakdown of Group 2 patients into BT shunt (BTS) n=58 vs. RV-PA conduit n=31 showed no difference in blood pressure gradients or arch dimensions for the ascending, transverse and distal anastomosis. RV-PA conduit patients had smaller proximal descending aortas (6.1±0.9 vs. 7.0±1.6, p<.01) and aortic dimensions at the diaphragm (6.5±0.6 vs. 7.6±1.3, p<.01) resulting in greater CI (1.0±0.2 vs. 0.9±0.2, p=.01). Rates of reintervention were similar for BTS (2/58) and RV-PA (1/31) patients from Group 2.
Conclusion: The interdigitating technique dramatically decreases the incidence of recurrent arch obstruction following the NP. Similar successful results were seen with BTS and RV-PA conduits with larger distal native aortas in the BTS group likely reflecting the different physiology of the shunts.