Recoarctation After Norwood I Procedure for Hypoplastic Left Heart Syndrome: Impact of Patch Material

Vitanova, Keti; Cleuziou, Julie; Ohain, Jelena Pabst von; Burri, Melchior; Eicken, Andreas; Lange, Rüdiger

doi:10.1016/j.athoracsur.2016.10.030

Cited by 34 publications

(20 citation statements)

References 14 publications

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“…Interestingly, in multivariable analyses we did not find associations between interdigitation and coarctectomy and our aortic end points, and our overall rates of intervention are consistent with other studies despite the apparent detriment of using GA treatment [11,12,21]. The importance of the biomaterial used for aortic reconstruction in terms of influencing recoarctation after the Norwood procedure has also been recently demonstrated by Vitanova and colleagues [12], who showed increased recoarctation with the use of equine pericardium.…”

Section: Commentsupporting

confidence: 88%

“…Baseline characteristics were compared between the treated and nontreated groups. The primary outcome of interest was freedom from any aortic reintervention [11], with secondary outcomes of freedom from any surgical aortic reintervention, freedom from development of an aortic pressure gradient of 20 mm Hg or greater [12], survival, and transplantation-free survival. The cumulative incidence of aortic reintervention was modeled using a semiparametric model developed with the stcrreg command within Stata, where aortic reintervention was the outcome of interest and death was the competing event.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Glutaraldehyde Treatment of Allografts and Aortic Outcomes Post-Norwood: Challenging Surgical Decision

Martin

Kaestner

Peng

et al. 2017

The Annals of Thoracic Surgery

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Section: Commentsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Glutaraldehyde Treatment of Allografts and Aortic Outcomes Post-Norwood: Challenging Surgical Decision

Martin

Kaestner

Peng

et al. 2017

The Annals of Thoracic Surgery

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“…Many biological and biosynthetic materials have been already studied as replacement of the abdominal wall 15 . Although routinely used in cardiothoracic and vascular surgery, neurosurgery, plastic surgery and orthopaedics [20][21][22][23][24][25][26][27]40,41 , equine pericardium has never been employed in bridging repair of the abdominal wall, perhaps because of described complications in other fields of employment likely related to host tissue reactions leading to degradation and leak 24 or fibrosis and shrinkage 41 .…”

Section: Discussionmentioning

confidence: 99%

Bridging repair of the abdominal wall in a rat experimental model. Comparison between uncoated and polyethylene oxide-coated equine pericardium meshes

Pasculli

Gurrado

Luca

et al. 2020

Sci Rep

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Biological meshes improve the outcome of incisional hernia repairs in infected fields but often lead to recurrence after bridging techniques. Sixty male Wistar rats undergoing the excision of an abdominal wall portion and bridging mesh repair were randomised in two groups: Group A (n = 30) using the uncoated equine pericardium mesh; Group B (n = 30) using the polyethylene oxide (PEO)-coated one. No deaths were observed during treatment. Shrinkage was significantly less common in A than in B (3% vs 53%, P < 0.001). Adhesions were the most common complication and resulted significantly higher after 90 days in B than in A (90% vs 30%, P < 0.01). Microscopic examination revealed significantly (p < 0.05) higher mesh integrity, fibrosis and calcification in B compared to A. The enzymatic degradation, as assessed with Raman spectroscopy and enzyme stability test, affected A more than B. the peo-coated equine pericardium mesh showed higher resistance to biodegradation compared to the uncoated one. Understanding the changes of these prostheses in a surgical setting may help to optimize the peo-coating in designing new biomaterials for the bridging repair of the abdominal wall. Incisional hernia affects 10-20% of laparotomies and represents the most common long-term complication after abdominal surgery 1-3. Since their first description by Usher et al. in 1985 4 , synthetic prostheses significantly reduced recurrence rate after the first incisional hernia repair, from more than 20% to less than 10% 5,6. Nevertheless, they are commonly contraindicated in situations in which the exposure to any additional bacterial burden constitutes an excessive risk of surgical site infection 7,8. According to the Ventral Hernia Working Group (VHWG), incisional hernias which are at high risk of surgical site occurrences, because of comorbidities or contamination/infection of the operative field, should be treated using biological meshes; this should also be recommended in those cases in which the complete rectus closure is not possible and bridging technique is unavoidable 9. Although some controversies arose about the influence of technique in determining the surgical site occurrences 10 , and other authors designed and validated other scores 11,12 , VHWG recommendations appear to be still the most reliable guidelines available in the

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“…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%

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

Yildirim¹,

Bakhshaliyev²,

Kilercik³

et al. 2019

J Card Surg

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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.

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Recoarctation After Norwood I Procedure for Hypoplastic Left Heart Syndrome: Impact of Patch Material

Abstract: The patch material used for reconstruction of the aortic arch in HLHS influences the rate of recoarctation following the Norwood I procedure. Equine pericardium cannot be recommended.

Cited by 34 publications

References 14 publications

Glutaraldehyde Treatment of Allografts and Aortic Outcomes Post-Norwood: Challenging Surgical Decision

Glutaraldehyde Treatment of Allografts and Aortic Outcomes Post-Norwood: Challenging Surgical Decision

Bridging repair of the abdominal wall in a rat experimental model. Comparison between uncoated and polyethylene oxide-coated equine pericardium meshes

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

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