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Evaluation of valved saphenous vein homograft as right ventricle-pulmonary artery conduit in modified stage I Norwood operation

Department of Cardiac Surgery, University of Tokyo School of Medicine, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

*Corresponding author. Tel.: +81-35800-8654; fax: +81-35684-3989.

E-mail address: koutakeuchi-circ{at}umin.ac.jp (K. Takeuchi).

Potential drawbacks from right ventricle-pulmonary artery (RV-PA) conduit in modified Norwood procedure may be regurgitation through the conduit and incision at the systemic ventricle. In order to address the question if valved RV-PA conduit can provide hemodynamic advantages, we retrospectively reviewed the data of patients who underwent modified stage I Norwood operation with either a non-valved ePTFE RV-PA conduit (ePTFE) or a valved saphenous vein homograft (SVG). Four patients in each group, both the ePTFE and SVG, were involved in the study and 2 patients in each group eventually died. Conduit regurgitation was seen mild to moderate-to-severe in all patients with ePTFE and mild in one patient with SVG. This regurgitation progressed over the next several months in the ePTFE group. Tricuspid regurgitation became worse in the ePTFE group, whereas it was improved in 2 patients within the SVG group. RV ejection fraction was reduced from 70±4% to 55±12% in the ePTFE group, whereas it was improved from 62±10% to 70±2% in the SVG group postoperatively (P<0.05). We conclude that conduit regurgitation may cause RV systolic dysfunction and prolong a functional recovery after modified stage I Norwood procedure. Saphenous vein homograft may be a choice as RV-PA conduit in this procedure.

Key Words: Stage I Norwood procedure; Hypoplastic left heart syndrome; Right ventricle-pulmonary artery shunt