Indications for and outcomes of interstage catheter interventions following the Norwood procedure: A single-institution study

AIMS: The aim of this study was to document the incidence, types, and outcome of interstage catheter interventions following the Norwood surgical palliation. PATIENTS AND METHODS: A retrospective single-center study of all patients surviving the Norwood operation was performed. All data concerning interstage catheter interventions up to the completion of the superior cavopulmonary shunt were collected. RESULTS: Catheter interventions were performed in 62 of 94 patients (66%; 38 males). These included interventions on the aortic arch (n = 44), the branch pulmonary arteries (PAs) (n = 17), and the Sano shunt (n = 14). Multiple interventions and repeat interventions were common. The minimum aortic arch diameter (pre- versus posttreatment) increased from median 3.1 (2.3–3.3) mm to 5.1 (4.2–6.2) mm (P < 0.001). The catheter pullback gradient decreased from 40 (36–46) mmHg to 9 (5–10) mmHg (P < 0.001), and the echocardiographic gradient from 54 (45–64) mmHg to 12 (10–16) mmHg (P < 0.001). The branch PA diameters increased from 2.4 (2.1–3.0) mmHg to 4.7 (4.2–5.1) mmHg (P < 0.001). The minimum Sano shunt diameters increased from 2.0 (1.5–2.1) mm to 5.9 (5.8–6.0) mm (P < 0.001); this was associated with an improvement in systemic saturation from 63% (60%–65%) to 80% (79–82%) (P < 0.001). Unexpected interstage death at home occurred in two patients who had received no interventions. The remainder received a superior cavopulmonary shunt palliation. CONCLUSIONS: Catheter interventions were common. Systematic follow-up and a low threshold for reintervention are essential to the success of staged surgical palliation for this patient cohort.