Valved Conduit for Norwood-Sano Procedure

Abstract

Use of a valved Sano (VS) during the Norwood procedure has been reported previously, but is not widely used and its impact on clinical outcomes needs to be further elucidated. Our institution shifted practice to the VS operation entirely in 2019, using a valved femoral venous homograft. We describe our technique in the present report. The VS technique is well codified and highly reproducible. Pre-Glenn echocardiograms showed competent conduit valves in two-thirds of the VS patients (n = 16/25, 66.7%). We retrospectively reviewed 25 consecutive HLHS neonates who underwent a Norwood procedure with a VS conduit using a femoral venous homograft and 25 consecutive HLHS neonates who underwent a Norwood procedure with a non-valved Sano (NVS) conduit between 2013 and 2022. Hospital survival for the VS group was 96%. Postoperatively, VS patients had significantly lower peak and postoperative day 1 lactate levels (p=0.033 and p=0.025 respectively), shorter time to diuresis (p=0.043), and shorter time to enteral feeds (p=0.038). The VS group had significantly fewer PA reinterventions until the Glenn (n=1 vs 8; p=0.044). The VS group showed significant improvement in ventricular function from the immediate post-operative period to discharge (p<0.001). From preoperative to pre-Glenn time points, analysis of ventricular function showed sustained ventricular function within the VS group, but a significant reduction of ventricular function in the NVS group (p=0.003). The use of a valved conduit for Norwood-Sano procedure is a reproducible technique, associated with improved multi-organ recovery, ventricular function recovery and fewer PA reinterventions.