The "double dunk" technique for a right ventricle to pulmonary artery conduit for the Norwood procedure reduces the unintended shunt-related events.

BACKGROUND: The introduction of the 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 interventions.

AIM: We analyse how several modifications employed in RVPAc for NP may influence the interstage course, surgical or catheter-based unintended interventions and pulmonary arteries development in HLHS cohort of patients.

METHODS: We performed a retrospective analysis of three groups of non-selected, consecutive neonates who underwent the NP between 2011 and 2014, with different RVPAc surgical techniques employed: Group I - the left RVPAc with distal homograft cuff [ N=32 ], Group II - the right RVPAc with distal homograft cuff [ N=28 ], Group III - the "double dunk" right reinforced RVPAc [ N=41 ].

RESULTS: There was no difference 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 ) between the groups. There was a significant reduction in the numbers of catheter-based interventions during the interstage period in the third group (34 vs. 25vs. 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 the 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 catheter-based and surgical unintended shunt-related reinterventions during the interstage period. This strategy allows for a more homogenous development of pulmonary arteries before the second, surgical stage.