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Januszewska, Katarzyna; Lehner, Anja; Schmidt, Christoph; Stegger, Julia; Nawrocki, Pawel and Malec, Edward (2021): Cobra-Head Cuffed Vascular Graft as Right Ventricle-to-Pulmonary Artery Shunt in Norwood Procedure. In: Annals of Thoracic Surgery, Vol. 112, No. 1: pp. 156-161

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Background. Right ventricle-to-pulmonary artery (RV PA) shunt as a part of the Norwood procedure underwent many modifications. We present our experience with a commercially available polytetrafluoroethylene vascular graft with cobra-head cuff as an RV-PA shunt. Methods. A consecutive series of 52 children with hypoplastic left heart syndrome (median age 8 [range, 2-68] days, median weight 3200 [range, 2060-4400] g) underwent the Norwood procedure with a cobra-head cuffed RV-PA shunt (6 mm). The cuffed end was used for the central PA reconstruction. A retrospective analysis of clinical results, PAs development, and shunt-related complications, interventions, and technique of Glenn operation was performed. The study endpoint was Glenn operation with shunt removal or interstage death. Results. The hospital and late interstage mortality was 3.8% (n = 2 of 52) and 4% (n = 2 of 50), respectively, and was not shunt-related. During mean follow of 3.7 +/- 2.5 years, 48 (92.3%) children underwent Glenn operation at a median age of 6 (range, 2.6-9.1) months. Angiography before the second stage revealed satisfactory branch PAs development (maximum and minimum McGoon ratio of 1.95 +/- 0.36 and 1.38 +/- 0.38, respectively). The mean maximal diameter of the left PA was smaller than that of the right PA (7.13 +/- 2.1 mm vs 8.42 +/- 2.2 mm;P 1/4 .017), without differences in mean minimal diameter. Two infants required stent implantation in proximal shunt end and 1 required urgent Glenn operation because distal shunt thrombosis. During Glenn operation, 11 (22.9%) children required patch reconstruction of central PAs. Conclusions. The cobra-head cuffed graft allowed easy and reproducible reconstruction of the central PA during the Norwood procedure. Using this technique, the development of PAs is satisfactory, the rate of shunt related complications and interventions is low, and the second stage can be performed without patch material. (Ann Thorac Surg 2021;112:156-62) (c) 2021 by The Society of Thoracic Surgeons

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