Experience With Bovine Pericardium for the Reconstruction of the Aortic Arch in Patients Undergoing a Norwood Procedure

Abstract

The incidence of recurrent aortic arch obstruction after the Norwood procedure is between 0% and 36%. Allograft material is frequently used to enlarge the aorta; its use has been associated with the development of significant allosensitization. We report our experience using bovine pericardium for the reconstruction of the aortic arch in patients undergoing a Norwood procedure. A retrospective analysis of 33 consecutive patients evaluated for a second-stage procedure after an initial Norwood repair was performed. All patients underwent a cardiac catheterization. The presence of recurrent arch obstruction (gradient > 10 mm Hg) and its management were noted. Three consecutive patients were tested for anti-HLA antibodies at the time of their Fontan procedure. The mean age at the time of the cardiac catheterization was 4.12 months (range, 2 to 7 months). The incidence of recurrent arch obstruction was 18.2% (6 patients). Four patients (12.1%) had distal obstruction, 1 patient (3%) had proximal obstruction, and 1 patient (3%) had mid-transverse arch obstruction. Five of the 6 patients underwent aortic arch reintervention consisting of four balloon dilatations and two surgical patch aortoplasties. Thirty-one patients advanced to a second-stage procedure, including 30 bidirectional Glenn anastomoses, and 1 Rastelli repair. No significant allosensitization was present in the patients tested. The use of bovine pericardium in the Norwood procedure is associated with an acceptable incidence of recurrent arch obstruction. Its availability, lower cost, and possible immunologic advantages make it an attractive alternative to allograft material.