open access

Vol 76, No 12 (2018)
Original articles
Published online: 2018-08-07
Submitted: 2018-04-25
Accepted: 2018-08-03
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The “double dunk” technique for a right ventricle to pulmonary artery conduit implantation during the Norwood procedure reduces unintended shunt-related events

Tomasz Mroczek, Julita Sacharczuk, Rafał Żurek, Aleksandra Morka, Aleksandr Szypulski, Jerzy Jarosz, Maciej Śniechowski, Janusz H. Skalski
DOI: 10.5603/KP.a2018.0172
·
Pubmed: 30091131
·
Kardiol Pol 2018;76(12):1697-1704.

open access

Vol 76, No 12 (2018)
Original articles
Published online: 2018-08-07
Submitted: 2018-04-25
Accepted: 2018-08-03

Abstract

Background: The introduction of a right ventricle to pulmonary artery conduit (RVPAc) during the Norwood procedure (NP) for hypoplastic left heart syndrome (HLHS) resulted in a higher survival rate, but also in an increased number of unintended pulmonary and shunt-related interventions.

Aim: To analyse how several modifications employed in RVPAc implantation during NP may influence the interstage course, unintended surgical or catheter-based interventions, and pulmonary artery development in a cohort of patients with HLHS.

Methods: We retrospectively analysed three groups of non-selected, consecutive neonates who underwent the NP between 2011 and 2014, with different RVPAc surgical techniques employed: Group I (n = 32) — left RVPAc with distal homograft cuff, Group II (n = 28) — right RVPAc with distal homograft cuff, and Group III (n = 41) — “double dunk,” right reinforced RVPAc (n = 41).

Results: There were no intergroup differences 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). There was a significant difference between the groups in the number of catheter-based interventions during the interstage period (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 most homogenous in the third group.

Conclusions: The modified strategy of using the “double dunk,” right reinforced RVPAc during the NP for HLHS significantly reduces the number of unintended catheter-based and surgical shunt-related reinterventions during the interstage period. This technique allows a more homogenous development of pulmonary arteries before the second, surgical stage.

Abstract

Background: The introduction of a right ventricle to pulmonary artery conduit (RVPAc) during the Norwood procedure (NP) for hypoplastic left heart syndrome (HLHS) resulted in a higher survival rate, but also in an increased number of unintended pulmonary and shunt-related interventions.

Aim: To analyse how several modifications employed in RVPAc implantation during NP may influence the interstage course, unintended surgical or catheter-based interventions, and pulmonary artery development in a cohort of patients with HLHS.

Methods: We retrospectively analysed three groups of non-selected, consecutive neonates who underwent the NP between 2011 and 2014, with different RVPAc surgical techniques employed: Group I (n = 32) — left RVPAc with distal homograft cuff, Group II (n = 28) — right RVPAc with distal homograft cuff, and Group III (n = 41) — “double dunk,” right reinforced RVPAc (n = 41).

Results: There were no intergroup differences 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). There was a significant difference between the groups in the number of catheter-based interventions during the interstage period (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 most homogenous in the third group.

Conclusions: The modified strategy of using the “double dunk,” right reinforced RVPAc during the NP for HLHS significantly reduces the number of unintended catheter-based and surgical shunt-related reinterventions during the interstage period. This technique allows a more homogenous development of pulmonary arteries before the second, surgical stage.

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Keywords

hemi-Fontan procedure, hypoplastic left heart syndrome, Norwood operation

About this article
Title

The “double dunk” technique for a right ventricle to pulmonary artery conduit implantation during the Norwood procedure reduces unintended shunt-related events

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 76, No 12 (2018)

Pages

1697-1704

Published online

2018-08-07

DOI

10.5603/KP.a2018.0172

Pubmed

30091131

Bibliographic record

Kardiol Pol 2018;76(12):1697-1704.

Keywords

hemi-Fontan procedure
hypoplastic left heart syndrome
Norwood operation

Authors

Tomasz Mroczek
Julita Sacharczuk
Rafał Żurek
Aleksandra Morka
Aleksandr Szypulski
Jerzy Jarosz
Maciej Śniechowski
Janusz H. Skalski

References (20)
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