Norwood Operation with Right Ventricular–Pulmonary Artery Shunt Versus Comprehensive Stage II After Bilateral Pulmonary Artery Banding Palliation

• Published in: Pediatric cardiology 2024-06, Vol.45 (5), p.943-952
• Main Authors: Miwa, Koji, Iwai, Shigemitsu, Kanaya, Tomomitsu, Kawai, Shota
• Format: Article
• Language: English
• Subjects: Cardiac Surgery; Cardiology; Female; Fontan Procedure - adverse effects; Fontan Procedure - methods; Heart Ventricles - surgery; Hemodynamics; Humans; Hypoplastic Left Heart Syndrome - surgery; Infant; Infant, Newborn; Male; Medicine; Medicine & Public Health; Norwood Procedures - adverse effects; Norwood Procedures - methods; Palliative Care - methods; Pulmonary Artery - surgery; Retrospective Studies; Review; Treatment Outcome; Vascular Surgery
• ISSN: 0172-0643; 1432-1971; 1432-1971
• DOI: 10.1007/s00246-023-03258-y

As a strategy for the primary Norwood operation, the right ventricular–pulmonary artery shunt is associated with satisfactory early outcome. However, use of this shunt after bilateral pulmonary artery banding remains controversial. This study compared the operative outcomes and late hemodynamics in patients who underwent the Norwood operation, preceded by bilateral pulmonary artery banding, with a right ventricular–pulmonary artery shunt or with bidirectional Glenn anastomosis (comprehensive stage II strategy). We retrospectively reviewed 38 patients who underwent the Norwood operation preceded by bilateral pulmonary artery banding between 2004 and 2017. Of these, 17 underwent the Norwood operation with a right ventricular–pulmonary artery shunt (Group S), whereas 21 underwent the comprehensive stage II strategy (Group G). 5 years after the Norwood operation, 10 (60%) and 17 (81%) patients in Group S and Group G, respectively, underwent the Fontan procedure. Group S showed significantly lower pressure in the superior vena cava after bidirectional Glenn anastomosis than Group G (13 ± 2 mmHg vs. 18 ± 3 mmHg; p