A reinforced right-ventricle-to-pulmonary-artery conduit for the stage-1 Norwood procedure improves pulmonary artery growth

Abstract

A ring-reinforced conduit is associated with reduced intervention, as well as higher pulse pressures and improved pulmonary artery growth, in infants undergoing stage-1 palliation for HLHS.

Femoral Vein Homograft as Right Ventricle to Pulmonary Artery Conduit in Stage 1 Norwood Operation

“…This is the first series of neonates with use of cryopreserved FVH as RV to PA conduit. The PA growth was much better than reported in other studies [3,5,20]. In addition, single ventricular function was well preserved in most of the patients.…”

“…Hypoplasia of the branch PA can have deleterious effects on a circulation that will ultimately be dependent on passive venous return. In an effort to address this issue, Bentham and associates [5] described the use of a ring-reinforced conduit with proximal "dunking" into the RV. They noted an increase in the branch PA dimensions and a reduction in the number of reinterventions with use of ring-reinforced conduit.…”

“…Although the RV to PA conduit confers improved hemodynamic stability, the PTFE tube is associated with suboptimal branch pulmonary growth and thrombosis [2,4]. Moreover, the effects of pulmonary insufficiency over the function of the single ventricle can be detrimental in the long run [4,5].…”

Early results of ring‐reinforced conduit and curved porcine patch in Sano‐Norwood procedure

“…The cross‐clamp times were longer in our patient’s group as expected since we performed the RV‐PA conduit interposition during the aortic cross‐clamp period. However, Bentham et al found no evidence that indicates the longer cross‐clamp period resulted in increased postoperative morbidity, and prolonged intensive care or hospital stay in the ring‐reinforced Sano group in their series. A recent modification with a “double dunk” technique is speculated to provide more homogenous growth of pulmonary arteries following stage 1 palliation .…”

Commentary: The Achilles' heel of the stage 1 palliation

“…The reintroduction of the RV-PA conduit into the neonatal palliation of hypoplastic left heart syndrome 2 has been reported to improve early survival 3 ; its effects on right ventricular function and pulmonary artery growth, however, are still debated. 4,5 The use of supported, nonvalved grafts placed through limited right ventricular incisions 6 may help to reduce the injury to the ventricle and thus the need for postoperative interventions 7 ; however, early conduit regurgitation with resultant ventricular volume loading and anastomotic distortion and bleeding may still be a concern.…”