The Journal of thoracic and cardiovascular surgery · 2026
Right versus left pulmonary artery anastomosis of the right ventricle-to-pulmonary artery conduit in Norwood procedure: Comparable outcomes with longer Glenn operative time.
СтатьяНазвание и аннотация: Перевод в очереди
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Yamashita Eijiro, Nugent Alan, Allen Kiona, Davila Allison B, Martin Elisabeth, Mongé Michael C, Winlaw David S
Аннотация
OBJECTIVE: In the modified Norwood procedure for hypoplastic left heart syndrome, right ventricle-to-pulmonary artery (RV-PA) conduit laterality is largely surgeon dependent. We evaluated whether conduit laterality influences early outcomes and subsequent bidirectional Glenn (BDG) surgery.
METHODS: We retrospectively reviewed consecutive patients with hypoplastic left heart syndrome or hypoplastic left heart complex undergoing Norwood with an RV-PA conduit between September 2023 and March 2026. Patients were stratified according to whether the RV-PA conduit was positioned to the right (R-PA) or left (L-PA) of the reconstructed neoaorta. Early outcomes, pre-BDG hemodynamics, and BDG operative variables were compared.
RESULTS: Thirty-one patients were included (R-PA, n = 15; L-PA, n = 16). Age at Norwood (5 vs 4.5 days) and body weight (3.27 vs 3.30 kg) were similar. Early mortality (0 vs 1), extracorporeal membrane oxygenation use (1 vs 2), unplanned RV-PA conduit stenting (2 vs 1), and PA stenting (4 vs 2) did not differ between groups (all P > .05). Pre-BDG catheterization demonstrated comparable hemodynamics, including cardiac index (3.3 vs 4.0 L/min/m2), pulmonary-to-systemic blood flow ratio (1.20 vs 1.33), pulmonary vascular resistance (1.21 vs 1.59 WU), and mean PA pressure (13.5 vs 12.0 mm Hg) (all P > .05). At BDG, atrioventricular valve regurgitation greater than mild occurred in 2 patients per group, body weight and Norwood-to-BDG interval were similar. However, cardiopulmonary bypass time was significantly shorter in the R-PA (93 vs 195 minutes, P = .033).
CONCLUSIONS: RV-PA conduit laterality does not influence early Norwood outcomes or pre-BDG physiology. Left-sided conduit placement is associated with longer BDG CPB time, suggesting increased operative complexity.
METHODS: We retrospectively reviewed consecutive patients with hypoplastic left heart syndrome or hypoplastic left heart complex undergoing Norwood with an RV-PA conduit between September 2023 and March 2026. Patients were stratified according to whether the RV-PA conduit was positioned to the right (R-PA) or left (L-PA) of the reconstructed neoaorta. Early outcomes, pre-BDG hemodynamics, and BDG operative variables were compared.
RESULTS: Thirty-one patients were included (R-PA, n = 15; L-PA, n = 16). Age at Norwood (5 vs 4.5 days) and body weight (3.27 vs 3.30 kg) were similar. Early mortality (0 vs 1), extracorporeal membrane oxygenation use (1 vs 2), unplanned RV-PA conduit stenting (2 vs 1), and PA stenting (4 vs 2) did not differ between groups (all P > .05). Pre-BDG catheterization demonstrated comparable hemodynamics, including cardiac index (3.3 vs 4.0 L/min/m2), pulmonary-to-systemic blood flow ratio (1.20 vs 1.33), pulmonary vascular resistance (1.21 vs 1.59 WU), and mean PA pressure (13.5 vs 12.0 mm Hg) (all P > .05). At BDG, atrioventricular valve regurgitation greater than mild occurred in 2 patients per group, body weight and Norwood-to-BDG interval were similar. However, cardiopulmonary bypass time was significantly shorter in the R-PA (93 vs 195 minutes, P = .033).
CONCLUSIONS: RV-PA conduit laterality does not influence early Norwood outcomes or pre-BDG physiology. Left-sided conduit placement is associated with longer BDG CPB time, suggesting increased operative complexity.