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The Annals of thoracic surgery2016; 103(2); 617-621; doi: 10.1016/j.athoracsur.2016.10.030

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.
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Publication Date: 2016-12-23 PubMed ID: 28024650DOI: 10.1016/j.athoracsur.2016.10.030Google Scholar: Lookup
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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

The Annals of thoracic surgery
ISSN: 1552-6259
NlmUniqueID: 15030100R
Country: Netherlands
Language: English
Volume: 103
Issue: 2
Pages: 617-621
PII: S0003-4975(16)31479-5

Researcher Affiliations

Vitanova, Keti
  • Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany. Electronic address: vitanova@dhm.mhn.de.
Cleuziou, Julie
  • Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
Pabst von Ohain, Jelena
  • Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
Burri, Melchior
  • Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
Eicken, Andreas
  • Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technische Universität München, Munich, Germany.
Lange, Rüdiger
  • 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.
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