The Norwood procedure using a right ventricle–pulmonary artery conduit: Comparison of the right-sided versus left-sided conduit position

Objective

We proposed that a right-sided right ventricle–pulmonary artery conduit during the stage I Norwood procedure would facilitate pulmonary artery reconstruction during the stage II procedure.

Methods

Between 2002 and 2006, 153 patients underwent Norwood stage I reconstruction with a right ventricle–pulmonary artery conduit (125 in the right-sided group and 28 in the left-sided group). The previous 150 consecutive classic Norwood procedures (1997–2002) were used as a control group. Outcomes from stages I and II were analyzed, including ventricular function and pulmonary artery morphology.

Results

The 30-day survival was 88% (110/125) in the right-sided group, 75% (21/28) in the left-sided group, and 70% (105/150) in the control group (P < .001, right-sided vs control groups). The conduit length was 35 ± 9 mm in the right-sided group and 26 ± 8 mm in the left-sided group (P = .001). Survival at 6 months demonstrated a significant survival benefit in the right-sided right ventricle–pulmonary artery conduit group over the control group (P = .009, log-rank test). There was no difference in ventricular function between the groups and no regional dyskinesia associated with the right ventricle–pulmonary artery conduit. Despite larger branch pulmonary artery size in the right ventricle–pulmonary artery conduit groups (compared with the control group), central pulmonary artery stenoses were common (62% in the right conduit and 80% in the left conduit). Bypass and ischemic times at stage II were 49 ± 10 and 23 ± 13 minutes in the right-sided group compared with 61.5 ± 9.5 and 31 ± 14 minutes in the left-sided group (P < .001 and P = .03, respectively). The 30-day mortality after the stage II procedure was 1.3% (1/76) in the right-sided group, 0% (0/18) in the left-sided group, and 3.3% (3/90) in the control group.

Conclusion

The right-sided conduit is a safe technique and has improved 30-day and overall post–stage II survival compared with that seen with the classic Norwood procedure. The right ventricle–pulmonary artery conduit is associated with central pulmonary artery stenosis but good development of the branch pulmonary arteries and preservation of ventricular function. The right-sided conduit significantly reduces cardiopulmonary bypass times at stage II.

Abbreviations and Acronyms: HLHS, hypoplastic left heart syndrome, PA, pulmonary artery, RV–PA, right ventricle–pulmonary artery

CTSNet classification: 21