THE “DOUBLE DUNK” TECHNIQUE FOR A RIGHT VENTRICLE TO PULMONARY ARTERY CONDUIT FOR THE NORWOOD PROCEDURE REDUCES THE UNINTENDED SHUNT-RELATED EVENTS.
Journal Title: INTERNATIONAL JOURNAL OF PURE MEDICAL RESEARCH - Year 2019, Vol 4, Issue 2
Abstract
Background: We describe how several modications employed in the RVPAc for the NP may inuence the interstage course, surgical or catheter-based unintended interventions and pulmonary arteries development in the HLHS cohort of patients. Methods: We performed a retrospective analysis of three groups of non-selected, consecutive neonates who underwent the NP between 2011 and 2014, with different RVPAc surgical techniques employed: Group I - the left RVPAc with distal homograft cuff [N=32], Group II – the right RVPAc with distal homograft cuff [N=28], Group III – the “double dunk” right reinforced RVPAc [N=41]. Results: There was no intergroup difference in terms of age, weight, prevalence of aortic atresia, diameter of the ascending aorta, deep hypothermic circulatory arrest time and hospital mortality rate (9.3 vs. 14.2 vs. 7.3%, respectively) between the groups. There was a signicant reduction in the numbers of catheter-based interventions during the interstage period in the third group (34 vs. 25 vs. 0%, respectively, p<0.05) and/or concomitant surgical interventions (17.2 vs. 4.1 vs. 2.6%, respectively). The diameter of the pulmonary arteries was the most homogenous in the third group. Conclusion: The modied strategy of using the “double dunk”, right reinforced RVPAc during the Norwood procedures for HLHS signicantly reduces the number of catheter-based and surgical unintended shunt-related reinterventions during the interstage period. This strategy allows for a more homogenous development of pulmonary arteries before the second surgical stage.
Authors and Affiliations
Tomasz Mroczek, Julita Sacharczuk, Rafał Żurek, Aleksandra Morka, Jerzy Jarosz, Maciej Sniechowski, Janusz H. Skalski
Keywords
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