Indications for and outcomes of interstage catheter interventions following the Norwood procedure: A single-institution study
Aims : The aim of this study was to document the incidence, types, and outcome of interstage catheter interventions following the Norwood surgical palliation. Patients and Methods : A retrospective single-center study of all patients surviving the Norwood operation was performed. All data concerning...
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| Main Authors: | , , , , , |
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| Format: | Book |
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Wolters Kluwer Medknow Publications,
2023-01-01T00:00:00Z.
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| Summary: | Aims : The aim of this study was to document the incidence, types, and outcome of interstage catheter interventions following the Norwood surgical palliation. Patients and Methods : A retrospective single-center study of all patients surviving the Norwood operation was performed. All data concerning interstage catheter interventions up to the completion of the superior cavopulmonary shunt were collected. Results : Catheter interventions were performed in 62 of 94 patients (66%; 38 males). These included interventions on the aortic arch (n = 44), the branch pulmonary arteries (PAs) (n = 17), and the Sano shunt (n = 14). Multiple interventions and repeat interventions were common. The minimum aortic arch diameter (pre- versus posttreatment) increased from median 3.1 (2.3-3.3) mm to 5.1 (4.2-6.2) mm (P < 0.001). The catheter pullback gradient decreased from 40 (36-46) mmHg to 9 (5-10) mmHg (P < 0.001), and the echocardiographic gradient from 54 (45-64) mmHg to 12 (10-16) mmHg (P < 0.001). The branch PA diameters increased from 2.4 (2.1-3.0) mmHg to 4.7 (4.2-5.1) mmHg (P < 0.001). The minimum Sano shunt diameters increased from 2.0 (1.5-2.1) mm to 5.9 (5.8-6.0) mm (P < 0.001); this was associated with an improvement in systemic saturation from 63% (60%-65%) to 80% (79-82%) (P < 0.001). Unexpected interstage death at home occurred in two patients who had received no interventions. The remainder received a superior cavopulmonary shunt palliation. Conclusions : Catheter interventions were common. Systematic follow-up and a low threshold for reintervention are essential to the success of staged surgical palliation for this patient cohort. |
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| Item Description: | 0974-2069 10.4103/apc.apc_125_22 |