title: Ring-reinforced Sano right ventricular to pulmonary artery conduit at Norwood stage I.
abstract: Reinterventions for proximal conduit obstruction or on the pulmonary arteries are frequent after Sano-modified stage I Norwood palliation of hypoplastic left heart syndrome. We report our experience with a modified Sano stage I, in which the right ventricle-to-pulmonary artery (PA) conduit used is reinforced by external rings to avoid collapse, and the conduit is inserted into the right ventricle through a limited ventriculotomy and 'dunked' into the ventricular cavity. In our experience, this modification was associated with fewer reinterventions or complications with the proximal anastomosis (P = 0.046 and 0.004), improved PA pulse pressure (9.1 ± 4.1 vs 4.8 ± 3.8 mmHg in controls, P < 0.001) and Nakata index (213 ± 76 vs 134 ± 68 mm(2)/m(2) in controls, P < 0.0001), although overall survival to a median of 20 months was not significantly different from controls. Right ventricular function at stage II-bidirectional Glen was marginally better in patients with the modified Sano conduit, however not to a significant level. Further evaluation of late ventricular function is currently ongoing.
authors.affiliation: Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA Cardiovascular Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland patrick.myers@hcuge.ch.
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Myers
authors.affiliation: Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Sitaram M
authors.initials: SM
authors.lastname: Emani
authors.affiliation: Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Baird
mesh_terms: D062186:Arterial Pressure / Q000502:physiology; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D058327:Norwood Procedures / Q000295:instrumentation* / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies
keywords: Hypoplastic left heart syndrome; Norwood operation; Sano modification; Single ventricle