Aortic arch configurations according to reconstruction methods following the Norwood procedure for hypoplastic left heart syndrome†

OBJECTIVES We investigated the relationship between aortic arch configuration and reconstruction methods used in the Norwood procedure.METHODS Our surgical database identified 162 patients who underwent the Norwood procedure for hypoplastic left heart syndrome, including variants, from January 2010 to December 2023. Of the 162 total cases, this study focused on the 135 patients who were assessed using computed tomography and aortic angiography. We have mainly employed direct anastomosis (direct), patch augmentation using an autologous pericardium (patch) and the chimney technique (chimney: another autologous reconstruction) as the methods for aortic arch reconstructions. According to the configurations of the postoperative aorta, arch geometry was defined as the Gothic, Crenel and Romanesque types. The following parameters were analysed: rates of intervention for recurrent coarctation (re-CoA), aortic distensibility and degree of tapering in the reconstructed aortic arch.RESULTS The Gothic, Crenel and Romanesque were observed in 18 (13.3%), 48 (35.6%) and 69 (51.1%) patients, respectively. Direct tends to induce Gothic configuration, whereas the Romanesque was frequently observed in the chimney. Direct (23.5%) and Gothic (33.3%) showed higher rates of re-CoA, while the chimney (1.8%) showed a lower rate. Furthermore, distensibility was higher in chimney (5.3 mmHg-1 in median) compared to the 2 other methods (direct: 3.2 mmHg-1, patch: 2.1 mmHg-1 in median). Additionally, the chimney showed lower tapering of the reconstructed aortic arch (chimney: 2.9 mm vs direct: 4.1 mm and patch: 3.5 mm in median).CONCLUSIONS Our findings suggested that the chimney technique was associated with a more favourable postoperative aortic configuration, lower rate of re-CoA and higher aortic distensibility than the other methods. Hypoplastic left heart syndrome (HLHS) is a complex congenital heart defect that requires a series of palliative surgeries, the first and most critical of which is the Norwood procedure.