Norwood-Sano Operation Using a Stentless Pulmonary Valved Conduit

Abstract

The Sano modification of Norwood's operation has the potential to generate an excess volume load on the single right ventricle as a consequence of diastolic reversal of flow through the conduit. This article describes the use of a new, small, biological conduit with a porcine valve inside. This new conduit has been used in modified Norwood procedures. It is interposed between the right ventricle and the confluence of the pulmonary arteries. The use of a valved conduit should prevent the retrograde diastolic blood flow observed with use of nonvalved conduits and may improve postoperative hemodynamics. The use of a new stentless valved conduit in 3 recent Norwood procedures is reported herein.

Interstage evaluation of homograft-valved right ventricle to pulmonary artery conduits for palliation of hypoplastic left heart syndrome

“…then, various groups have incorporated valves into the RV-PA conduit, including valved saphenous vein homografts, valved porcine xenografts, bovine pericardial conduits with porcine valves, and composite grafts using PTFE and Hemashield material. [20][21][22][23][24] Most of these experiences were described as case reports or case series, the largest of which comprised 34 patients ( 21) and 8 patients (20), 5 and 4 of whom had a VC, respectively. Currently, the significance of the diastolic conduit regurgitation on RV size and function in this population is not well understood.…”

Narrative review of single ventricle: where are we after 40 years?

“…In hypoplastic left heart syndrome, the surgical neonatal approach is the Norwood procedure, either with a modified Blalock-Taussig shunt ( 78 ) or with a Sano right ventricle to pulmonary artery conduit ( 79 ) with recent improvement in results ( 80 , 81 ). The Sano conduit has utilized either a ring reinforced tubular prosthesis ( 82 ), stent-less pulmonary valved conduit ( 83 ), or valved femoral venous homograft ( 84 ). The type of Sano conduit used is still primarily based upon institutional and surgeon preferences and will require longer follow-up to determine efficacy ( 85 ).…”

Aortic or Pulmonary Valved Homograft Right Ventricle to Pulmonary Artery Conduit in the Norwood Procedure

“…4,5 For completeness sake, we will mention another recent report from Spain using a stentless bovine valved conduit with good results. 6 We are a little concerned about the technical aspects of anastomosing this rather stiff conduit, but one must appreciate the fact that it is available off-the-shelf and does not carry the risk of HLA sensitization.…”

“…Recently, there have been additional reports of results using different valved modifications of RVPAC, using other materials. [4][5][6]…”