Periscopic Technique For Right Ventricle To Pulmonary Artery Conduit During The Norwood Operation
Ralph Mosca1, Richard Ohye2, David Williams1, Puneet Bhatla1, Shawn Thomas1, Luv Makadia1, TK S. Kumar1.
1NYU Langone Health, New York, NY, USA, 2University of Michigan, Ann Arbor, MI, USA.
Objective(s): In this video, we describe the periscopic technique (PT) for placement of the right ventricle to pulmonary artery (RV-PA) conduit in Norwood operation as an alternate method to the traditional technique (TT) to minimize the effects of ventriculotomy.
Methods: In the Norwood operation, the proximal connection of the RV-PA conduit was performed following transection of main PA during the cooling phase of cardiopulmonary bypass. In the PT, a stab wound was created in the RV outflow tract and gently stretched. A right angle was then passed through the RV outflow tract and out the divided PA. The appropriately tailored and marked conduit was then pulled gently in a retrograde fashion through the RV stab wound. No muscle was excised from the RV at any point. The distal connection of the RV-PA conduit was established by dunking it into a fenestration in the patch over the distal PA bifurcation. We retrospectively reviewed our experience of RV-PA conduit placement using the TT versus PT and compared postoperative RV function using standard statistical methods. Echocardiograms were reviewed by a blinded experienced imager for quantification of RV function (infundibular ejection fraction (EF)) as well as for regional conduit site wall dysfunction
Results: 8 patients underwent TT and 14 patients underwent PT. Mean infundibular RVEF was 34% and 49 %( p=0.02) respectively. Similarly qualitative regional RV wall function was better preserved in PT (p=0.001).
Conclusions: Usage of PT for RV-PA conduit placement in Norwood operation is associated with better preservation of RV function.
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