Aortic Arch Reconstruction in the Norwood Procedure: The “Reimplantation” Technique

Abstract

Arch reconstruction as part of the Norwood Procedure is a challenging 3-dimensional task that has to combine the aortic and pulmonary roots in a Damus-Kaye-Stansel anastomosis and also reconstruct the hypoplastic aortic arch, usually with concomitant coarctation. Compression or torsion of the aortic root can compromise coronary blood flow, especially in the setting of a diminutive native aortic root. This technique focuses on maximum augmentation of the aortic root with separate implantation of the pulmonary root into the reconstructed aortic arch – this maintains the natural spatial relationship of the aortic and pulmonary roots. The technique has the advantage of being reproducible across all morphological variants in hypoplastic left heart syndrome as well as in other situations where the Norwood is used such as with transposed great arteries and interrupted aortic arch.