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J Thorac Cardiovasc Surg 2005;130:61-65
© 2005 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Interdigitating arch reconstruction eliminates recurrent coarctation after the Norwood procedure

^a Department of Cardiothoracic Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa
^b Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
^c Section of Pediatric Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada

Received for publication June 15, 2004; revisions received November 15, 2004; accepted for publication February 22, 2005.

^_* Address for reprints: Harold M. Burkhart, MD, University of Iowa, Department of Cardiothoracic Surgery, 200 Hawkins Dr, 1603 JCP, Iowa City, IA 52242 (Email: harold-burkhart{at}uiowa.edu).

BACKGROUND: We sought to determine whether evolving techniques of aortic arch reconstruction used during the Norwood procedure decreased the incidence of postoperative aortic arch obstruction.

METHODS: Our technique for aortic arch reconstruction in patients undergoing the Norwood procedure has evolved from using an allograft patch (classic group, n = 26) to primary connection of the pulmonary artery and arch (autologous group, n = 20). More recently, we have used a novel technique involving coarctation excision, an extended end-to-end anastomosis on the back of the arch, and a counterincision on the anterior descending aorta to sew in an allograft patch for total arch reconstruction (interdigitating group, n = 33). Cardiac catheterizations performed before stage II palliation were reviewed for aortic diameters at multiple levels in 79 infants (median age, 4.2 months). Aortic arch obstruction was defined as a ratio between the diameters of the arch anastomosis and the descending aorta (coarctation index) of less than 0.7.

RESULTS: Overall, 15 (19%) children had aortic arch obstruction. All 15 required aortic intervention (balloon angioplasty, n = 12; surgical patch angioplasty, n = 2; both, n = 1). Aortic arch obstruction rates for the classic, autologous, and interdigitating groups were 46% (n = 12), 15% (n = 3), and 0%, respectively (P > .001).

CONCLUSION: Reconstruction of the aortic arch with excision of ductal and coarctation tissue is associated with lower aortic arch obstruction rates in patients undergoing the Norwood procedure. Arch reconstruction with a novel interdigitating technique decreases the incidence of aortic arch obstruction.

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