title: Improved Results of Aortic Arch Reconstruction in the Norwood Procedure.
abstract: BACKGROUND
  Despite several surgical modifications, the reported incidence of neoaortic coarctation after stage 1 palliation (S1P) of hypoplastic left heart syndrome remains high. A modification of aortic arch reconstruction that may decrease the incidence of neoaortic coarctation after S1P is described.
  
  
  METHODS
  Between January 2008 and May 2013, 114 patients with hypoplastic left heart syndrome underwent S1P. The hospital records of the 101 surviving patients (89%) were reviewed. Demographic data and perioperative variables for S1P were collected. A modified technique for aortic arch reconstruction that contains a bovine pericardial patch tailored and sutured in a specific way was used in 51 patients (group MT), whereas the traditional technique was used in 50 patients (group TT). Clinical echocardiographic and cardiac catheterization data were analyzed to determine the incidence and location of neoaortic coarctation.
  
  
  RESULTS
  There were no significant differences in the baseline characteristics, the intraoperative course, or hospital mortality between the two groups of subjects. Duration of ventilation, intensive care unit stay, and hospitalization were significantly shorter in group MT. The mean follow-up was 2.02 ± 0.63 years and 3.98 ± 0.66 years in each group, respectively. Coarctation developed in 4 of 51 patients (7.8%) in group MT compared with 10/50 patients (20%) in group TT. Multivariable logistic regression analysis showed that the estimated odds of coarctation for group MT were 0.41 (95% confidence interval: 0.04, 4.32) times the estimated odds of coarctation for group TT.
  
  
  CONCLUSIONS
  The described technique may decrease the incidence of recoarctation after S1P by minimizing aortic arch and descending aorta distortion and providing ample enlargement of the aorta at its narrowest diameter.
authors.affiliation: Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: ferns@email.unc.edu.
authors.forename: Sunita J
authors.initials: SJ
authors.lastname: Ferns
authors.affiliation: Department of Surgery, Advocate Children's Hospital, Oak Lawn, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Chawki
authors.initials: C
authors.lastname: El Zein
authors.affiliation: Department of Surgery, Advocate Children's Hospital, Oak Lawn, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Siva Prasad
authors.initials: SP
authors.lastname: Maruboyina
authors.affiliation: Department of Surgery, Advocate Children's Hospital, Oak Lawn, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Sujata
authors.initials: S
authors.lastname: Subramanian
authors.affiliation: Department of Pediatrics, Advocate Children's Hospital, Oak Lawn, Illinois.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Van Bergen
authors.affiliation: Department of Surgery, Advocate Children's Hospital, Oak Lawn, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Michel N
authors.initials: MN
authors.lastname: Ilbawi
mesh_terms: D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001017:Aortic Coarctation / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006328:Cardiac Catheterization; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D015994:Incidence; D007223:Infant; D008297:Male; D058327:Norwood Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000379:methods*