Recoarctation of the aorta after the Norwood procedure may be treated during the second stage of the surgical palliation

OBJECTIVES: Recoarctation of the aorta (re-CoA) after the Norwood procedure is traditionally treated during catheter-based aortoplasty (CB-A) performed as a separate procedure preceding stage II surgical palliation (S II SP). Our goal was to determine the efficacy of the protocol according to which re-CoA after the Norwood procedure in patients with hypoplastic left heart syndrome is treated during S II SP using hybrid catheter-based aortoplasty. METHODS: We compared 2 groups of infants who developed re-CoA after the Norwood procedure and were treated at the same institution: In group I (n = 18), CB-A was traditionally performed before S II SP; in group II (n = 15), CB-A was performed during S II SP using a hybrid procedure (catheter access was through an aortic cannula routinely used for cardiopulmonary bypass). The right ventricular fractional area change was analysed. RESULTS: The CB-A was performed effectively in both groups. S II SP was performed at a younger age in group II (5.4 +/- 0.3 vs 6.0 +/- 0.4 months; P = 0.003), with lower body weight (5.6 +/- 0.5 vs 6.0 +/- 0.4; P = 0.03, respectively). The duration of hospital stay did not differ between the groups (10.6 +/- 6.2 vs 11.6 +/- 6.4 days; P = 0.91). The right ventricular fractional area change measured before S II SP was higher in group I (39.7 +/- 4.2% vs 36.8 +/- 3.6%, respectively; P = 0.009), but the difference was not seen 1 month after S II SP (41.0 +/- 5.6 vs 39.8 +/- 4.1; P > 0.05). The total radiation dose was significantly lower in group II. CONCLUSIONS: re-CoA after the Norwood procedure in patients with hypoplastic left heart syndrome can be treated effectively during S II SP using a hybrid procedure. The strategy allows for reduction of the total radiation dose and of the number of procedures and does not prolong the postoperative course, even in patients with decreased right ventricular systolic function.