Does the size of pulmonary artery impact on recoarctation of the aorta after the Norwood procedure without patch?

OBJECTIVES
This study aimed to evaluate whether recoarctation of the aorta (reCoA) after the Norwood procedure for hypoplastic left heart syndrome correlates with pre- and postoperative anatomic factors.

METHODS
This retrospective study included 48 patients who underwent Norwood procedure with right ventricle-to-pulmonary artery conduit between 2009 and 2017. Anatomical factors such as preoperative length, diameter of the main pulmonary artery (MPA), and postoperative neoaortic arch angle stratified by arch reconstruction technique were analysed using the receiver operating characteristic analysis.

RESULTS
Eleven patients needed surgical intervention for reCoA at stage 2. Out of the 30 patients who underwent direct anastomosis during arch reconstruction, 7 developed reCoA. Seven patients received the full patch augmentation (patch augmentation for both lesser and greater curvatures) and were all spared from reCoA. Among the patients who had direct anastomosis, the preoperative MPA length was correlated with the postoperative arch angle (P = 0.021) and was associated with the occurrence of reCoA (P = 0.002) and the best cutoff value for MPA length was 10 mm. The postoperative arch angle was also correlated with the incidence of reCoA (P < 0.001) and was larger in patients who underwent the full patch augmentation than in patients who had direct anastomosis (126° vs 112°, P = 0.005) despite comparable MPA length.

CONCLUSIONS
ReCoA after the Norwood procedure correlates with MPA length when a direct anastomosis was used. Direct anastomosis can be considered in patients with a longer preoperative MPA. In other cases, the full patch augmentation should be considered for obtaining a large and smooth neoaortic arch.

This is an Accepted Manuscript of an article published by Oxford University Press. This fulltext is available in June 2022. This is a pre-copyedited, author-produced version of an article accepted for publication in Interactive Cardio Vascular and Thoracic Surgery following peer review. The version of record [Yasuyuki Kobayashi, Yasuhiro Kotani, Takuya Kawabata, Yosuke Kuroko, Shunji Sano, Shingo Kasahara, Does the size of pulmonary artery impact on recoarctation of the aorta after the Norwood procedure without patch?, Interactive CardioVascular and Thoracic Surgery, Volume 33, Issue 5, November 2021, Pages 765–772] is available online at: https://doi.org/10.1093/icvts/ivab170