Thorac Cardiovasc Surg 2014; 62 - OP111
DOI: 10.1055/s-0034-1367185

Modification of the Norwood procedure: Early experience with patch enlargement of the left pulmonary artery

T. Attmann 1, E. Pardun 2, J. Jussli-Melchers 1, C. Grothusen 1, O. Jung 2, G. Fischer 2, J. Cremer 1, H.-H. Kramer 2, J. Scheewe 1
  • 1Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Herz- und Gefäßchirurgie, Kiel, Germany
  • 2Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für angeborene Herzfehler und Kinderkardiologie, Kiel, Germany

Objectives: Adequately sized pulmonary arteries are crucial for the hemi-Fontan-type of circulation. The hemi-Fontan procedure is technically demanding, particularly with regard to patch augmentation of the left pulmonary artery dorsal to the neo-aorta. We have developed a new surgical technique to create a large left pulmonary artery (LPA) already during modified Norwood stage I procedure.

Methods: Our recent modification to the Norwood procedure involves the use of a porcine pericardial patch for enlargement of the left pulmonary artery. Between 10/2010 and 06/2011, 18 patients were operated with the new technique (group B). We compared their outcome with those of the preceding 18 patients (02/2010 - 09/2010) who underwent a conventional Norwood procedure and received enlargement of the left pulmonary artery not before hemi-Fontan surgery (group A).

Results: All patients survived Norwood and hemi-Fontan surgery. No differences between the groups concerning age or weight before Norwood and hemi-Fontan procedure could be found. Patch enlargement during the Norwood surgery did not significantly influence operating times (group A 3.8 ± 0.5 h vs group B 4.3 ± 1.6 h) or bypass times (group A 2.3 ± 0.5 h vs group B 2.4 ± 0.4 h). In contrast, hemi-Fontan operation times (group A 4.4 ± 0.9 h vs group B 4.0 ± 0.4 h) and bypass times (group A 2.4 ± 0.8 h vs group B 1.9 ± 0.8 h) tended to be shorter in patients with previously implanted LPA patch. Intensive care unit stay after Norwood procedure proved to be prolonged in group B (30 d, range 7-101) compared to group A (20 d, range 10-68, p < 0.05), but shorter after hemi-Fontan operation (group A 8.8 d, range 4-48 vs group B 6 d, range 3-27, p < 0.01). The total lower lobe index in group B calculated before hemi-Fontan operation was higher than in group A (163 ± 44 mm2/m2 vs 148 ± 56 mm2/m2) without reaching statistical significance.

Conclusions: The new technique proved to be as save as the conventional procedure with excellent early survival. The implantation of the LPA patch during Norwood stage I is comfortable compared to the implantation during hemi-Fontan. This subjective notion is verified by the shorter operation and bypass times. The new technique facilitates the hemi-Fontan operation without complicating the Norwood stage I procedure.