title: Ring-reinforced Sano conduit at Norwood stage I reduces proximal conduit obstruction.
abstract: BACKGROUND
  Reinterventions for proximal conduit obstruction or on the pulmonary arteries are frequent after the Sano-modified stage I Norwood palliation of hypoplastic left heart syndrome. We report our initial experience with a modified Sano technique using a ring-reinforced graft inserted transmurally through the right ventricle with a limited ventriculotomy.
  
  
  METHODS
  All patients who underwent the Sano-modified stage I Norwood procedure using a modified "dunked" technique from September 2010 to September 2012 at our institution were reviewed. An historical control group consisted of patients undergoing the traditional Sano right ventricle-to-pulmonary artery conduit anastomosed to the epicardium. The primary outcome measures included death, reintervention on the Sano and pulmonary arteries, and ventricular function.
  
  
  RESULTS
  The study included 29 patients. No patients required intervention on the Sano conduit, pulmonary arteries, or aortic arch before discharge after the stage I procedure. During a median follow-up of 20 months (range, 26 days to 3.3 years), survival was estimated at 96.6% ± 3.4% at 1 month and 86.2% ± 6.4% at the latest follow-up. One patient underwent heart transplantation. No interstage intervention was required on the proximal or distal Sano conduit. Intervention was required on the midportion of the conduit in 1 patient and on the pulmonary arteries in 3 patients. At the time of the bidirectional Glenn anastomosis, freedom from conduit and pulmonary artery intervention was estimated at 92.3% ± 7.4% and 90.1% ± 8.7%, respectively, and global right ventricular dysfunction was mild or less in 84% (16 of 19) of patients.
  
  
  CONCLUSIONS
  The ring-reinforced right ventricle-to-pulmonary artery Sano conduit transmurally inserted into the right ventricle provides acceptable results, with a low incidence of interstage reinterventions in patients undergoing stage I palliation.
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: christopher.baird@childrens.harvard.edu.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Baird
authors.affiliation: Division of Cardiovascular Surgery, Geneva University Hospitals and School of Medicine, Geneva, Switzerland.
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Myers
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Michele
authors.initials: M
authors.lastname: Borisuk
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pigula
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Sitaram M
authors.initials: SM
authors.lastname: Emani
mesh_terms: D001157:Arterial Occlusive Diseases / Q000517:prevention & control*; D002675:Child, Preschool; D006801:Humans; D058327:Norwood Procedures / Q000295:instrumentation* / Q000379:methods*; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000517:prevention & control*; D019736:Prostheses and Implants; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D011138:Polytetrafluoroethylene