MODIFIED NORWOOD PROCEDURE FOR HYPOPLASTIC LEFT-HEART SYNDROME

Background. Since June 1994, we have used a modification of the Norwoo d technique in 13 patients presenting with the hypoplastic left heart syndrome or similar variants. Methods. This technique involves coarcta tion repair, arch reconstruction, and creation of a neo-ascending aort a using autologous great vessel tissue only. Pulmonary blood now is pr ovided by a central shunt of 3.0- to 4.0-mm Gore-Tex. Results. The mea n age and weight at operation were 15 days (range, 1 to 77 days) and 3 .2 kg (range, 1.7 to 4.6 kg), respectively. The mean circulatory arres t time was 32 minutes (range, 25 to 50 minutes). There was one operati ve death, and there have been no late deaths. Seven patients have gone on to conversion to a bidirectional cavopulmonary shunt at a mean age of 6 months. There have been no cases of recurrent coarctation, arch obstruction, or left pulmonary artery stenosis. Significant coronary i nsufficiency requiring revision of the ascending aortic reconstruction has developed in 2 patients. Conclusions. We believe this approach of fers the advantage of using the patient's own native tissue for all gr eat vessel reconstruction. This technique may also allow 10 to 15 minu tes less of circulatory arrest time. The theoretic benefits include im proved growth of repaired structures and avoidance of homograft or pro sthetic material. The long-term results remain to be elucidated.