title: Recoarctation After Norwood I Procedure for Hypoplastic Left Heart Syndrome: Impact of Patch Material.
abstract: BACKGROUND
  The development of recoarctation after the Norwood I procedure is a known complication in patients with hypoplastic left heart syndrome (HLHS).
  
  
  METHODS
  We reviewed data on 194 consecutive patients with HLHS who underwent the Norwood I procedure between 2000 and 2015. All patients who survived until the second stage of the procedure were included. Recoarctation was defined by the need for intervention, either catheter based or surgical. The aim of our study was to determine if the patch material used for the initial arch reconstruction had an influence on the development of recoarctation.
  
  
  RESULTS
  The study population consisted of 145 patients. The patch material used for aortic arch reconstruction was either a homograft (n = 87), autologous pericardium (n = 23), equine pericardium (n = 28), or other material (n = 7). Recoarctation was documented in 27 patients (18%) at a median time of 4.3 months (range, 1 to 28 months) after completion of Norwood I. Freedom from recoarctation was 85% ± 4%, 86% ± 7%, and 30% ± 22% at 2 years for homograft, autologous pericardium, and equine pericardium, respectively. Thirty-six percent of patients with equine pericardium exhibited recoarctation, significantly more than homograft patch (p < 0.01) or autologous pericardium (p = 0.002). Treatment for recoarctation was percutaneous balloon angioplasty in 19 patients, stent implantation in 3, and operative enlargement of the aortic arch in 5. On univariate analysis, arch reconstruction with equine pericardium was the only risk factor for recoarctation (hazard ratio, 6.0; 95% confidence interval, 2.6-14; p < 0.01).
  
  
  CONCLUSIONS
  The patch material used for reconstruction of the aortic arch in HLHS influences the rate of recoarctation following the Norwood I procedure. Equine pericardium cannot be recommended.
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany. Electronic address: vitanova@dhm.mhn.de.
authors.forename: Keti
authors.initials: K
authors.lastname: Vitanova
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
authors.forename: Julie
authors.initials: J
authors.lastname: Cleuziou
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
authors.forename: Jelena
authors.initials: J
authors.lastname: Pabst von Ohain
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
authors.forename: Melchior
authors.initials: M
authors.lastname: Burri
authors.affiliation: Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technische Universität München, Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Eicken
authors.affiliation: Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery; D001017:Aortic Coarctation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D001027:Aortography; D001807:Blood Vessel Prosthesis; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures / Q000009:adverse effects*; D010496:Pericardium / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies