Interdigitating arch reconstruction eliminates recurrent coarctation after the Norwood procedure

Department of Cardiothoracic Surgery, Universaity of Iowa Hospital and Clinics, 200 Hawlins Drive, Iowa City, IA 52242, USA.
Journal of Thoracic and Cardiovascular Surgery (Impact Factor: 4.17). 07/2005; 130(1):61-5. DOI: 10.1016/j.jtcvs.2005.02.060
Source: PubMed


We sought to determine whether evolving techniques of aortic arch reconstruction used during the Norwood procedure decreased the incidence of postoperative aortic arch obstruction.
Our technique for aortic arch reconstruction in patients undergoing the Norwood procedure has evolved from using an allograft patch (classic group, n = 26) to primary connection of the pulmonary artery and arch (autologous group, n = 20). More recently, we have used a novel technique involving coarctation excision, an extended end-to-end anastomosis on the back of the arch, and a counterincision on the anterior descending aorta to sew in an allograft patch for total arch reconstruction (interdigitating group, n = 33). Cardiac catheterizations performed before stage II palliation were reviewed for aortic diameters at multiple levels in 79 infants (median age, 4.2 months). Aortic arch obstruction was defined as a ratio between the diameters of the arch anastomosis and the descending aorta (coarctation index) of less than 0.7.
Overall, 15 (19%) children had aortic arch obstruction. All 15 required aortic intervention (balloon angioplasty, n = 12; surgical patch angioplasty, n = 2; both, n = 1). Aortic arch obstruction rates for the classic, autologous, and interdigitating groups were 46% (n = 12), 15% (n = 3), and 0%, respectively ( P > .001).
Reconstruction of the aortic arch with excision of ductal and coarctation tissue is associated with lower aortic arch obstruction rates in patients undergoing the Norwood procedure. Arch reconstruction with a novel interdigitating technique decreases the incidence of aortic arch obstruction.

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    • "The reconstruction of the aortic arch has been performed by several [1] [2] [3] groups of authors without the use of any prosthetic material. Despite the techniques of surgical reconstruction, the aortic arch underwent multiple modifications, and the incidence of reintervention remains the same [2] [3] [4]. The materials used to enlarge the aorta could range from animal-derived tissue [4] to extracellular matrix-based scaffolds, which are cellularized by autologous progenitors and eventually digested [5]. "
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