The “double dunk” technique for a right ventricle to pulmonary artery conduit implantation during the Norwood procedure reduces unintended shunt-related events

Abstract

Background: The introduction of a right ventricle to pulmonary artery conduit (RVPAc) during the Norwood procedure (NP) for hypoplastic left heart syndrome (HLHS) resulted in a higher survival rate, but also in an increased number of unintended pulmonary and shunt-related interventions. Aim: To analyse how several modifications employed in RVPAc implantation during NP may influence the interstage course, unintended surgical or catheter-based interventions, and pulmonary artery development in a cohort of patients with HLHS. Methods: We retrospectively analysed three groups of non-selected, consecutive neonates who underwent the NP between 2011 and 2014, with different RVPAc surgical techniques employed: Group I (n = 32) - left RVPAc with distal homograft cuff, Group II (n = 28) - right RVPAc with distal homograft cuff, and Group III (n = 41) - “double dunk,” right reinforced RVPAc (n = 41). Results: There were no intergroup differences in terms of age, weight, prevalence of aortic atresia, diameter of the ascending aorta, deep hypothermic circulatory arrest time, and hospital mortality rate (9.3% vs. 14.2% vs. 7.3%, respectively). There was a significant difference between the groups in the number of catheter-based interventions during the interstage period (34% vs. 25% vs. 0%, respectively, p < 0.05) and/or concomitant surgical interventions (17.2% vs. 4.1% vs. 2.6%, respectively). The diameter of the pulmonary arteries was most homogenous in the third group. Conclusions: The modified strategy of using the “double dunk,” right reinforced RVPAc during the NP for HLHS significantly reduces the number of unintended catheter-based and surgical shunt-related reinterventions during the interstage period. This technique allows a more homogenous development of pulmonary arteries before the second, surgical stage.