Improved Results of Aortic Arch Reconstruction in the Norwood Procedure

Ferns, Sunita J.; Zein, Chawki El; Maruboyina, Siva Prasad; Subramanian, Sujata; Bergen, Andrew H. Van; Ilbawi, Michel N.

doi:10.1016/j.athoracsur.2016.01.079

Cited by 4 publications

(5 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…22 Several patch materials such as autologous pericardium, 23 porcine intestinal submucosa, 9 bovine pericardium, 24 and extracellular matrix-based scaffolds 25 and pulmonary homografts 26 with different geometric designs have been described to achieve the best results in terms of hemodynamics and growth potential. 27 to attenuate the pericardial calcification as well the host's inflammatory response. 28 In our opinion, this is particularly important, since the traditional cryopreserved allograft material is known to induce a host response in terms of anti-HLA antibody development and since like all other cases with single ventricle palliation, the patients with HLHS are possible candidates of heart transplantation in their future life.…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, the reconstruction of the aortic arch is still a challenging part of the Norwood procedure, since recoarctation of the aorta is known to be significantly related to increased morbidity and mortality . Several patch materials such as autologous pericardium, porcine intestinal submucosa, bovine pericardium, and extracellular matrix‐based scaffolds and pulmonary homografts with different geometric designs have been described to achieve the best results in terms of hemodynamics and growth potential . Several advantages and disadvantages of the currently used materials are known and there is no consensus about an ideal patch material for the arch repair in Norwood procedure.…”

Section: Commentmentioning

confidence: 99%

“…However, the No‐React biomodification is known to attenuate the pericardial calcification as well the host’s inflammatory response . In our opinion, this is particularly important, since the traditional cryopreserved allograft material is known to induce a host response in terms of anti‐HLA antibody development and since like all other cases with single ventricle palliation, the patients with HLHS are possible candidates of heart transplantation in their future life . Moreover, the handling of the curved porcine pericardial patch is easy and it perfectly fits the aortic arch and neoaorta due to its curved shape, which is an important advantage over flat patches like autologous pericardium.…”

Section: Commentmentioning

confidence: 99%

See 2 more Smart Citations

Early results of ring‐reinforced conduit and curved porcine patch in Sano‐Norwood procedure

Yildirim¹,

Bakhshaliyev²,

Kilercik³

et al. 2019

J Card Surg

View full text Add to dashboard Cite

Background Patch augmentation of the aortic arch as well as construction of an unobstructed pulmonary blood supply are two important surgical targets in patients with hypoplastic left heart syndrome. In this report, we aimed to present our preliminary results with a combination of two relatively new approaches in Norwood‐Sano procedure. Methods A retrospective analysis was performed in 10 newborns with the diagnosis of hypoplastic left heart syndrome. Our surgical approach incorporated the interposition of a 6.0‐mm ring‐reinforced tube graft with the “dunked technique” between the right ventricle and the pulmonary artery; and reconstruction of the aortic arch using a curved porcine pericardial patch which is specifically designed for the Norwood procedure. Results Mean age and body weight at the time of the Sano‐Norwood operation were 7.3 ± 2.4 days and 3164 ± 406 g, respectively. We encountered 1 (10%) early and 1 (10%) late mortality. All of the patients were discharged without any residual gradients at the aortic arch. Four out of eight patients underwent stage 2 bidirectional cavopulmonary anastomosis at a median age of 5 months (range, 4‐6 months). Pericardial patch augmentation of the left pulmonary artery was deemed mandatory in one of our patients. Conclusions The dunked technique of interposing a ring‐reinforced conduit between the right ventricle and pulmonary artery along with the utilization of a curved porcine pericardial patch specifically designed for aortic arch reconstruction are promising modifications of the Sano‐Norwood procedure in newborns with hypoplastic left heart syndrome.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

See 1 more Smart Citation

Early results of ring‐reinforced conduit and curved porcine patch in Sano‐Norwood procedure

Yildirim¹,

Bakhshaliyev²,

Kilercik³

et al. 2019

J Card Surg

View full text Add to dashboard Cite

show abstract

“…Employing enough but not too much patching in each patient is challenging, and there is no standard technique guaranteeing success [29]. Upcoming techniques for three-dimensional tissue grafts may help the surgeon achieve uniform tapering and undistorted geometry [7,30].…”

Section: Left Hilar Spacementioning

confidence: 99%

“Less patch more growth?”: comparing two different schools of thought in aortic arch reconstruction techniques during Norwood I

Uzdenov¹,

Ballazhi²,

Kroll³

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: We compared two different philosophies at one institution with respect to arch-geometry and clinical results: no/minimal patch vs. abundant patch augmentation. Methods: Single center retrospective analysis of the interstage angiographies of 82 patients: 41 (50%) underwent stage I Norwood-type palliation with minimal/no patch material for arch augmentation (Group 1, 2001-2011), and 41 (50%) with an abundant use of patch material (Group 2, 2011-2019). Aortic arch angle, distal arch:descending ratio, planimetry of whole arch, left hilar space were quantified. Clinical endpoints were all interstage interventions on the aortic arch, left pulmonary artery and readmissions due to left lung atelectasis and respiratory failure. Results: Arch angles were more acute in Group 1 (81°±13,2 vs. 90°±10,28, P = .012), with no difference in left hilar space (0,28±0,08 vs. 0,29±0,06, P = .43). Distal arch:descending ratio was smaller in Group 1 (0,72±0,2 vs 0,86±0,19, P = .04). Interstage interventions on the aortic arch and descending aorta were provided in 17 (41,5%) patients in Group 1 versus 19 (46,3%) patients in Group 2. Transcatheter interventions on the left pulmonary artery were necessary in 18 Group 1 patients versus 18 Group 2 patients (43,9%). Unilateral left lung atelectasis and respiratory failure occurred in 2 patients (4,4%) in Group 1 and in 3 patients (7,3%) in Group 2. Conclusions: Abundant patch material is associated with less acute aortic arch angles and leads to significantly better distal arch growth. However, this theoretical geometric benefit did not lead to greater left hilar space, nor did it prove to be superior with respect to interstage-interventions on left hilar structures. Mid-term no clinical effect was detected but future long-term effects are substantial.

show abstract

“…Achieving adequate but not excessive patching in each patient is challenging, and there is not a standard technique available that can guarantee success. 12,25 Upcoming techniques for 3-dimensional tissue grafts could be used to help the surgeon to achieve uniform tapering and undistorted geometry.…”

Section: Reintervention and Recoarctationmentioning

confidence: 99%

Geometry and growth of the reconstructed aorta in patients with hypoplastic left heart syndrome and variants

Haller

Chetan

Saedi

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

Improved Results of Aortic Arch Reconstruction in the Norwood Procedure

Abstract: The described technique may decrease the incidence of recoarctation after S1P by minimizing aortic arch and descending aorta distortion and providing ample enlargement of the aorta at its narrowest diameter.

Cited by 4 publications

References 27 publications

Early results of ring‐reinforced conduit and curved porcine patch in Sano‐Norwood procedure

Early results of ring‐reinforced conduit and curved porcine patch in Sano‐Norwood procedure

“Less patch more growth?”: comparing two different schools of thought in aortic arch reconstruction techniques during Norwood I

Geometry and growth of the reconstructed aorta in patients with hypoplastic left heart syndrome and variants

Contact Info

Product

Resources

About