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Improved Results of Aortic Arch Reconstruction in the Norwood Procedure  Sunita J. Ferns, MD, MRCPCH (UK), Chawki El Zein, MD, Siva Prasad Maruboyina,

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Presentation on theme: "Improved Results of Aortic Arch Reconstruction in the Norwood Procedure  Sunita J. Ferns, MD, MRCPCH (UK), Chawki El Zein, MD, Siva Prasad Maruboyina,"— Presentation transcript:

1 Improved Results of Aortic Arch Reconstruction in the Norwood Procedure 
Sunita J. Ferns, MD, MRCPCH (UK), Chawki El Zein, MD, Siva Prasad Maruboyina, MBBS, Sujata Subramanian, MD, Andrew H. Van Bergen, MD, Michel N. Ilbawi, MD  The Annals of Thoracic Surgery  Volume 102, Issue 1, Pages (July 2016) DOI: /j.athoracsur Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 Hypoplastic left heart depicting arch anatomy preoperatively.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 An incision is made across the coarctation, and the periductal area is completely excised. The incision across the coarctation is extended into the thoracic descending aorta beyond the second intercostal arteries. (A) Ascending aorta, (B) junction of the arch with the descending aorta, and (C) distal tip of the incision. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 The longitudinal incision extends from the left lateral aspect of the ascending aorta to curve posteriorly and inferiorly to the anterior and medial aspect of the descending aorta. The inset demonstrates the relationship between the ascending (A) and descending (B) aorta planes of incision. (C) is the distal tip of the incision. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 Upper and lower body perfusion through ballooned catheters in the innominate artery and descending thoracic aorta. (A) Ascending aorta, (B) junction of the arch with the descending aorta, and (C) distal tip of the incision. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 A T-shaped bovine pericardial patch is fashioned with the wider end length equal to the diameter of the pulmonary artery. The suture line starts at the junction of the arch (B) with the descending aorta (B), rather than at the distal tip of the incision (C). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

7 Fig 6 The proximal end of the patch is cut and fashioned to fit into the proximal aortopulmonary anastomosis at B (junction of the arch with the descending aorta). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

8 Fig 7 Final patch shape after completion of arch reconstruction showing (B) a cobra head enlargement of the distal end of the incision. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

9 Fig 8 Traditional approach with an ellipsoid patch and suture line (B) starts at the distal end of the aortic incision (B). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

10 Fig 9 Kaplan-Meier survival curves for groups MT and TT. (COGPS = coarctation groups; CUM = cumulative.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

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