Re-coarctation after Norwood I Procedure for Hypoplastic Left Heart Syndrome - Impact of Patch Material

Objectives: The development of a re-coarctation after the Norwood I procedure is a known complication in patients with hypoplastic left heart syndrome (HLHS).

Methods: Data of 194 consecutive patients with HLHS who underwent Norwood I procedure between 2000 and 2015 were reviewed. All patients who survived until the second-stage procedure were included in the study. Re-coarctation was defined as an angiographic gradient over the aortic arch of ≥ 20mmHg or an aortic narrowing of more than 50%. The aim of our study was to determine the influence of different patch materials on the development of a re-coarctation.

Results: The study population consisted of 147 patients. Patch material for aortic reconstruction was homograft (n = 87), autologous pericardium (n = 23), equine pericardium (n = 28) and other material (n = 9). Re-coarctation was documented in 27 patients (18%) at a median time of 4.3 months [1–28] after Norwood I. Re-coarctation was present in 37% of the patients with equine pericardium. Freedom from re-coarctation was 85 ± 4%, 86 ± 7% and 30 ± 22% at 2 years for homograft, autologous pericardium and equine pericardium, respectively. The equine pericardium had a higher rate of re-coarctation compared with homograft patch (p< 0.01) and to autologous pericardium (p = 0.002). Percutaneous balloon angioplasty was performed in 19 patients, 3 patients had a stent implanted and 5 patients underwent operative enlargement of the aortic arch. In the univariate analysis, equine pericardium was the only risk factor for re-coarctation (HR 6.0; 95%CI 2.6–14; p< 0.01).

Conclusions: The patch material used for the reconstruction of aorta in HLHS patients influences the rate of re-coarctation following Norwood I procedure. The equine pericardium cannot be recommended for the reconstruction of the aortic arch.