Risk Factor for Recoarctation after Norwood Operation

Yasuyuki Kobayashi ¹, Yasuhiro Kotani ¹, Yosuke Kuroko ¹, Naohiro Horio ¹, Sachiko Kawada ¹, Sadahiko Arai ¹, Shunji Sano ², Shingo Kasahara ¹

¹ Okayama university hospital, Okayama, Japan; ² University of California, San Francisco, San Francisco, USA;

Date, time and location: 2018.05.26 08:30, Press Hall, 2F

Abstract

Objective: Recoarctation of reconstructed aortic arch after Norwood operation poses a risk for right ventricular dysfunction. We sought to evaluate whether or not the dimension of main pulmonary artery (MPA) affects on the occurrence of recoarctation.

Methods: A retrospective review was performed in 57 patients undergoing Norwood operation with RV-PA shunt between 2009 and 2016. Data was analyzed in 35 patients who were evaluated the length between the pulmonary valve annulus and bifurcation and the diameter of MPA by preoperative echocardiogram or computed tomography (CT). Aortic arch angle and diameter were measured by lateral view of CT before stage II. Recoarctation was defined by the need for catheter or surgical intervention. Thirty-five patients were divided into two groups based on the occurrence of recoarctation: group N (no reCoA; n = 25) and group R (reCoA; n = 10).

Results:The diameter of MPA was comparable between the groups (group N: 11.0［IQR: 10.2-13.1］ mm, group R: 10.7［9.9-11.3］ mm, p= 0.10). The length of MPA in group R was significantly shorter than that in group N (group N: 10.2［9.3-11.3］mm vs. group R: 8.4［8.0-9.0］mm, p= 0.04). The arch angle in group N was significantly larger than that in group R (group N: 120°［110-130］vs. group R: 106°［101-112］, p= 0.001).

Conclusions: Shorter main PA and sharp angle of reconstructed aortic arch appeared to be risk factors for recoarctation in patients having Norwood operation.