title: Homograft valved right ventricle to pulmonary artery conduit as a modification of the Norwood procedure.
abstract: BACKGROUND
  The use of a right ventricle to pulmonary artery (RV-PA) conduit in the Norwood procedure has been proposed to increase postoperative hemodynamic stability. A valve within the conduit should further decrease RV volume load. We report our clinical experience with this modification.
  
  
  RESULTS
  From February 2002 through August 2005, we performed 88 consecutive Norwood procedures using RV-PA conduits. We used composite valved conduits made from cryopreserved homograft and polytetrafluoroethylene (PTFE) in 66 cases (54 pulmonary, 12 aortic homografts), other valved conduits in 14, and unvalved PTFE in 8 cases. Hospital survival was 88.6% overall and increased to 93.1% after the initial year. Early interventions were required in 18 patients (16 for cyanosis). Prestage II cardiac catheterization was performed at a mean age of 126 days. Mean Qp/Qs was 1, with mean aortic saturation 71%, mean O2 extraction 24%, and mean right ventricular end-diastolic pressure 9 mm Hg. Patient weight, use of an aortic homograft valve in the conduit, stage I palliation within the first year of our experience, and low O2 extraction and high transpulmonary gradient prestage II were risk factors for overall death. Early interventions were more frequent in aortic valve conduits compared with all other conduits.
  
  
  CONCLUSIONS
  The valved RV-PA conduit was associated with low early mortality after the Norwood procedure. The majority of these patients had normal cardiac output and well-maintained RV function. There may be a higher risk for early conduit interventions and death when aortic valve homografts are used in the RV-PA conduit.
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, California 94305, USA. orx@stanford.edu
authors.forename: Olaf
authors.initials: O
authors.lastname: Reinhartz
authors.forename: V Mohan
authors.initials: VM
authors.lastname: Reddy
authors.forename: Edwin
authors.initials: E
authors.lastname: Petrossian
authors.forename: Malcolm
authors.initials: M
authors.lastname: MacDonald
authors.forename: John J
authors.initials: JJ
authors.lastname: Lamberti
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Roth
authors.forename: Gail E
authors.initials: GE
authors.lastname: Wright
authors.forename: Stanton B
authors.initials: SB
authors.lastname: Perry
authors.forename: Sam
authors.initials: S
authors.lastname: Suleman
authors.forename: Frank L
authors.initials: FL
authors.lastname: Hanley
mesh_terms: D001015:Aortic Arch Syndromes / Q000151:congenital / Q000601:surgery*; D001021:Aortic Valve / Q000637:transplantation*; D001705:Bioprosthesis; D006328:Cardiac Catheterization; D015331:Cohort Studies; D015897:Comorbidity; D003490:Cyanosis; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007231:Infant, Newborn; D015993:Life Tables; D008297:Male; D010166:Palliative Care; D011138:Polytetrafluoroethylene; D011651:Pulmonary Artery / Q000601:surgery*; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D014184:Transplantation, Homologous; D014683:Vena Cava, Superior / Q000601:surgery
chemical_list: D011138:Polytetrafluoroethylene