title: Coarctectomy combined with an interdigitating arch reconstruction results in a lower incidence of recurrent arch obstruction after the Norwood procedure than coarctectomy alone.
abstract: OBJECTIVE
  Recurrent aortic arch obstruction after the Norwood procedure continues to be a source of morbidity. We sought to determine if a modified interdigitating technique for aortic arch reconstruction during the Norwood procedure decreased recurrent arch obstruction.
  
  
  METHODS
  A total of 142 consecutive infants undergoing the Norwood procedure were divided into groups according to surgical technique: Group 1 (n = 79, January 1999 to May 2003) underwent arch reconstruction with complete coarctectomy followed by anastomosis of the descending aorta to the transverse arch. Group 2 (n = 63, June 2003 to September 2006) underwent complete coarctectomy plus a modified interdigitating technique. Catheterization before stage 2 palliation was reviewed for hemodynamics and angiographic arch dimensions, and a coarctation index was calculated.
  
  
  RESULTS
  Reintervention for recurrent coarctation occurred in 28% (22/79) of group 1 patients compared with 2% (1/63) of group 2 patients (P = .001). Aortic pressures, gradients, dimensions, and coarctation index were consistently more favorable for group 2.
  
  
  CONCLUSIONS
  Coarctectomy plus an interdigitating arch anastomosis was superior to coarctectomy alone and resulted in a dramatically decreased incidence of recurrent arch obstruction.
authors: Section of Pediatric Cardiology, Department of Pediatrics, The Medical College of Wisconsin, Milwaukee, WI, USA.
authors: Luke J
authors: LJ
authors: Lamers
authors: Peter C
authors: PC
authors: Frommelt
authors: Kathleen A
authors: KA
authors: Mussatto
authors: Robert D B
authors: RD
authors: Jaquiss
authors: Michael E
authors: ME
authors: Mitchell
authors: James S
authors: JS
authors: Tweddell
mesh_terms: D000714:Anastomosis, Surgical; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography; D016009:Chi-Square Distribution; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures / Q000009:adverse effects; D010166:Palliative Care; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014922:Wisconsin