CHSS - Does The Valved Modification To The Sano Conduit Matter: Early Physiologic Impact Of Valved Versus Non-valved Sano Conduit After Norwood Palliation

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Does The Valved Modification To The Sano Conduit Matter: Early Physiologic Impact Of Valved Versus Non-valved Sano Conduit After Norwood Palliation
Jordan Griffiths, MD, Rohit Loomba, MD, Julia Kaniuk, BS, David Winlaw, MD, Allison B. Davila, MD.
Ann & Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Background: During Norwood palliation the addition of a valved component to the Sano conduit seems to physiologically increase pulmonary blood flow (Qp). We sought to validate this using high-frequency physiologic data aggregated by Sickbay. Methods: Neonates who underwent Norwood palliation with a valved (n=21) or non-valved (n=9) Sano conduit were included. High-frequency physiologic data from the first 48 hours were analyzed. Systemic blood flow (Qs), Qp, Qp:Qs, renal oxygen extraction ratio (ROER), indexed systemic vascular resistance (SVRi), mean circulatory filling pressure (MCFP), and venous resistance were modeled longitudinally using locally estimated scatterplot smoothing. Propensity-score matching and linear mixed effects modeling incorporated time, valved Sano status, afterload reduction dose, and SVRi. Results: Valved Sano patients showed increases in Qp and Qp:Qs, with higher SVRi and venous resistance; these differences attenuated as SVRi declined, however they did require higher doses of milrinone early postoperatively. In mixed effects modeling, valved Sano status was independently associated with higher Qp:Qs (β=0.208, p=0.047) and MCFP (β=1.780, p=0.045). Despite early pulmonary flow predominance, ROER did not worsen and trended lower in valved patients later. There were no significant differences in reintubation, cardiac arrest, or mortality. Conclusions: Following Norwood palliation, circulatory physiology appears strongly influenced by elevated Qp in the valved Sano patients, which is associated with higher SVRi. Early afterload reduction may be useful in optimizing flow balance in these patients.

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