Recoarctation After Norwood I Procedure for Hypoplastic Left Heart Syndrome: Impact of Patch Material.
Abstract: The development of recoarctation after the Norwood I procedure is a known complication in patients with hypoplastic left heart syndrome (HLHS). Methods: We reviewed data on 194 consecutive patients with HLHS who underwent the Norwood I procedure between 2000 and 2015. All patients who survived until the second stage of the procedure were included. Recoarctation was defined by the need for intervention, either catheter based or surgical. The aim of our study was to determine if the patch material used for the initial arch reconstruction had an influence on the development of recoarctation. Results: The study population consisted of 145 patients. The patch material used for aortic arch reconstruction was either a homograft (n = 87), autologous pericardium (n = 23), equine pericardium (n = 28), or other material (n = 7). Recoarctation was documented in 27 patients (18%) at a median time of 4.3 months (range, 1 to 28 months) after completion of Norwood I. Freedom from recoarctation was 85% ± 4%, 86% ± 7%, and 30% ± 22% at 2 years for homograft, autologous pericardium, and equine pericardium, respectively. Thirty-six percent of patients with equine pericardium exhibited recoarctation, significantly more than homograft patch (p < 0.01) or autologous pericardium (p = 0.002). Treatment for recoarctation was percutaneous balloon angioplasty in 19 patients, stent implantation in 3, and operative enlargement of the aortic arch in 5. On univariate analysis, arch reconstruction with equine pericardium was the only risk factor for recoarctation (hazard ratio, 6.0; 95% confidence interval, 2.6-14; p < 0.01). Conclusions: 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.
Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Publication Date: 2016-12-23 PubMed ID: 28024650DOI: 10.1016/j.athoracsur.2016.10.030Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Journal Article
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
The research focused on the impact of patch material used in the Norwood I procedure executed on patients with hypoplastic left heart syndrome (HLHS), specifically studying its role in the development of recoarctation. It found that the type of patch material used significantly influences the rate of recoarctation, and that using equine pericardium leads to an elevated risk.
Research Participants and Methodology
- The research involved the examination of data from 194 consecutive patients diagnosed with HLHS who underwent the Norwood I procedure between 2000 and 2015.
- From these patients, those who survived to the second stage of the procedure were included in the study, making up a population of 145 patients.
- Recoarctation was identified by the requirement for an intervention, be it catheter-based or surgical.
Nature and Role of Patch Material
- A variety of materials were used as patches for aortic arch reconstruction, classified as homografts, autologous pericardium, equine pericardium, and others.
- The research aimed to study the relationship between the type of patch material used and the development of recoarctation.
Findings
- Recoarctation occurred in 27 of the patients (representing 18%) approximately 4.3 months after the Norwood I procedure was completed.
- The survival rate without recoarctation was 85%, 86%, and 30% at two years for patients with homograft, autologous pericardium, and equine pericardium patches, respectively.
- Significantly, 36% of patients with the equine pericardium patch experienced recoarctation, a notably higher percentage compared to the 18% overall incidence in the entire study population.
Treatment For Recoarctation and Risk Factors
- Treatment procedures for recoarctation included percutaneous balloon angioplasty, stent implantation, and operative enlargement of the aortic arch.
- Upon analysis, the research established that equine pericardium as a patch material for arch reconstruction presented as the only risk factor associated with recoarctation.
Conclusions
- The study concluded that the patch material deployed for reconstructing the aortic arch during the Norwood I procedure has a definitive impact on the development of recoarctation in HLHS patients.
- Due to the increased risk of recoarctation, the utilization of equine pericardium for this process is strongly discouraged.
Cite This Article
APA
Vitanova K, Cleuziou J, Pabst von Ohain J, Burri M, Eicken A, Lange R.
(2016).
Recoarctation After Norwood I Procedure for Hypoplastic Left Heart Syndrome: Impact of Patch Material.
Ann Thorac Surg, 103(2), 617-621.
https://doi.org/10.1016/j.athoracsur.2016.10.030 Publication
Researcher Affiliations
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany. Electronic address: vitanova@dhm.mhn.de.
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technische Universität München, Munich, Germany.
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
MeSH Terms
- Aorta, Thoracic / surgery
- Aortic Coarctation / diagnosis
- Aortic Coarctation / etiology
- Aortic Coarctation / surgery
- Aortography
- Blood Vessel Prosthesis
- Child, Preschool
- Female
- Follow-Up Studies
- Humans
- Hypoplastic Left Heart Syndrome / diagnosis
- Hypoplastic Left Heart Syndrome / surgery
- Infant
- Infant, Newborn
- Male
- Norwood Procedures / adverse effects
- Pericardium / transplantation
- Plastic Surgery Procedures / methods
- Recurrence
- Reoperation
- Retrospective Studies
Citations
This article has been cited 17 times.- Marathe SP. Commentary: the ideal patch material for congenital cardiac surgery: one ring to rule them all?. Interdiscip Cardiovasc Thorac Surg 2023 Mar 2;36(3).
- van Beynum IM, Kurul S, Krasemann T, Dalinghaus M, de Woestijne PV, Etnel JR, Bogers AJJC. Reconstruction of the Aortic Arch in Neonates and Infants: The Importance of Patch Material. World J Pediatr Congenit Heart Surg 2021 Jul;12(4):487-491.
- Kobayashi Y, Kotani Y, Kawabata T, Kuroko Y, Sano S, Kasahara S. Does the size of pulmonary artery impact on recoarctation of the aorta after the Norwood procedure without patch?. Interact Cardiovasc Thorac Surg 2021 Oct 29;33(5):765-772.
- Elassal AA, Al-Radi OO, Zaher ZF, Dohain AM, Abdelmohsen GA, Mohamed RS, Fatani MA, Abdelmotaleb ME, Noaman NA, Elmeligy MA, Eldib OS. Equine pericardium: a versatile alternative reconstructive material in congenital cardiac surgery. J Cardiothorac Surg 2021 Apr 23;16(1):110.
- Kiraly L, Vijayavenkataraman S. Biofabrication in Congenital Cardiac Surgery: A Plea from the Operating Theatre, Promise from Science. Micromachines (Basel) 2021 Mar 21;12(3).
- Yoo SJ, Hussein N, Peel B, Coles J, van Arsdell GS, Honjo O, Haller C, Lam CZ, Seed M, Barron D. 3D Modeling and Printing in Congenital Heart Surgery: Entering the Stage of Maturation. Front Pediatr 2021;9:621672.
- Durko AP, Yacoub MH, Kluin J. Tissue Engineered Materials in Cardiovascular Surgery: The Surgeon's Perspective. Front Cardiovasc Med 2020;7:55.
- Pasculli A, Gurrado A, De Luca GM, Mele A, Marzullo A, Mangone A, Cellamare S, Ferraro V, Maqoud F, Caggiani MC, Rana F, Cavallaro G, Prete FP, Tricarico D, Altomare CD, Testini M. Bridging repair of the abdominal wall in a rat experimental model. Comparison between uncoated and polyethylene oxide-coated equine pericardium meshes. Sci Rep 2020 Apr 24;10(1):6959.
- Corno AF, Smith P, Bezuska L, Mimic B. Is Decellularized Porcine Small Intestine Sub-mucosa Patch Suitable for Aortic Arch Repair?. Front Pediatr 2018;6:149.
- Kizilski SB, Recco DP, Davee JM, Masterson A, Yao J, Earley PD, Kneier NE, Aycock KI, Craven BA, Pathmanathan P, Hammer PE, Hoganson DM. Preclinical Validation of a Patient-Specific Patch-Planning Workflow for Congenital Cardiovascular Reconstruction. Ann Biomed Eng 2025 Dec;53(12):3505-3522.
- Ide Y, Gabbert D, Hansen JH, Uebing A, Voges I. MRI Assessment of Energy Loss Within the Thoracic Aorta and Its Impact on Cardiac Function in Fontan Patients After Aortic Reconstruction. J Magn Reson Imaging 2025 Nov;62(5):1397-1407.
- Zhao Z, Wu C, Dai J, Lu S, He L, Tian J, Jin X, Pan Z. End-to-side anastomosis and autologous pulmonary artery patch for aortic coarctation and hypoplastic aortic arch. J Thorac Dis 2025 Feb 28;17(2):959-968.
- Sun M, LaSala VR, Giuglaris C, Blitzer D, Jackman S, Ustunel S, Rajesh K, Kalfa D. Cardiovascular patches applied in congenital cardiac surgery: Current materials and prospects. Bioeng Transl Med 2025 Jan;10(1):e10706.
- Kimura S, Hirata Y, Shibata M, Ono M. Azygos Vein Patch for Enlarging Anastomosis of Ascending Aorta and Neoaorta After Norwood Procedure. Ann Thorac Surg Short Rep 2023 Mar;1(1):96-98.
- Sun H, Cheng Z, Guo X, Gu H, Tang D, Wang L. Comparison of Biomechanical and Microstructural Properties of Aortic Graft Materials in Aortic Repair Surgeries. J Funct Biomater 2024 Aug 28;15(9).
- Recco DP, Kizilski SB, Marshall LE, Earley PD, Kneier NE, Del Nido PJ, Hammer PE, Hoganson DM. Mechanical failure analysis of patch materials used in aortic arch reconstruction: implications for clinical practice. Eur J Cardiothorac Surg 2023 Nov 1;64(5).
- Weixler VHM, Kuschnerus K, Romanchenko O, Ovroutski S, Cho MY, Berger F, Sigler M, Sinzobahamvya N, Photiadis J, Murin P. Mid-term performance of decellularized equine pericardium in congenital heart surgery. Interact Cardiovasc Thorac Surg 2022 Nov 7;36(3).
Use Nutrition Calculator
Check if your horse's diet meets their nutrition requirements with our easy-to-use tool Check your horse's diet with our easy-to-use tool
Talk to a Nutritionist
Discuss your horse's feeding plan with our experts over a free phone consultation Discuss your horse's diet over a phone consultation
Submit Diet Evaluation
Get a customized feeding plan for your horse formulated by our equine nutritionists Get a custom feeding plan formulated by our nutritionists
