• Interact Cardiovasc Thorac Surg · Mar 2018

    Surgical strategy for aortic arch reconstruction after the Norwood procedure based on numerical flow analysis.

    • Shohei Miyazaki, Kagami Miyaji, Keiichi Itatani, Norihiko Oka, Shinji Goto, Masanori Nakamura, Tadashi Kitamura, Tetsuya Horai, Koichi Sughimoto, Yuki Nakamura, and Naoki Yoshimura.
    • Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
    • Interact Cardiovasc Thorac Surg. 2018 Mar 1; 26 (3): 460-467.

    ObjectivesInefficient aortic flow after the Norwood procedure is known to lead to the deterioration of ventricular function due to an increased cardiac workload. To prevent the progression of aortic arch obstruction, arch reconstruction concomitant with second-stage surgery is recommended. The aim of this study was to determine the indications for reconstruction based on numerical simulation and to reveal the morphology that affects the haemodynamic parameters.MethodsFifteen patients who underwent the Norwood procedure or arch repair and Damus-Kaye-Stansel anastomosis were enrolled. The pressure gradient in aortic arch was 1.6 ± 3.9 mmHg (ranged from 0 to 12 mmHg) on catheter examination. Six patients who had prominent turbulent flow accompanied with a large flow energy loss index greater than 40 mW/m2 and high wall shear stress greater than 100 Pa underwent arch reconstruction.ResultsAfter arch reconstruction, the energy loss index significantly decreased from 88.5 ± 50.0 mW/m2 to 23.1 ± 10.4 mW/m2 (P = 0.026) and wall shear stress significantly decreased from 194.5 ± 87.4 Pa to 60.3 ± 40.5 Pa (P = 0.0062). There were 3 late deaths due to heart failure caused by progressive atrioventricular valve regurgitation during the follow-up period (60 months). The systemic ventricular function was preserved in the remaining patients without any pressure gradients in the arch.ConclusionsDetermining the surgical strategy for arch reconstruction based on numerical flow analysis may effectively reduce the ventricular load even if no stenosis or pressure gradients are observed on catheter examination or echocardiography.© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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