Abstract 16411: Intraoperative Nicardipine Use During Rewarming in Norwood Procedures

Introduction: Postoperative tissue edema Norwood procedures contributes significantly to outcomes. As nicardipine preserves ventricular function after hypothermic ischemic arrest, nicardipine treatment could support post-Norwood ventricular function, and decrease edema to improve patient outcomes. Methods: All Norwood procedures completed at a single institute between 1/1/2012 - 12/31/2019 were retrospectively reviewed, and the use of nicardipine during rewarming was initiated midway through the study period. We investigated the effects of nicardipine during rewarming on 12-month postoperative mortality, postoperative intubation times, open chest duration, and disposition at discharge. Results: Thirty-six Norwood procedures were completed, of whom 14 received nicardipine intraoperatively during the rewarming period. The nicardipine group demonstrated significantly lower 12-month postoperative mortality (0% vs 32%, p-value: 0.028) and significantly greater discharges to home (64% vs 18%, p-value: 0.005). The nicardipine group had lower median length of postoperative intubation (123 vs 146 hrs, p-value: 0.311) and open sternum time (2 [1-3] vs 3 [2-5] days, p-value: 0.067), but these analyses did not reach statistical significance (Fig 1). Conclusion: This study demonstrates the safety of nicardipine treatment during Norwood and significant decrease 12-month mortality and increase in discharge to home, with potential for reduced post-Norwood intubation and open sternum times. This study provides the basis for a prospective randomized controlled trial to demonstrate survival benefit provided by intraoperative nicardipine usage during Norwoods.

Aortic or Pulmonary Valved Homograft Right Ventricle to Pulmonary Artery Conduit in the Norwood Procedure

Background: Several modifications of the Norwood procedure utilizing valved right ventricle to pulmonary artery conduits have recently been reported. Our group has been using aortic or pulmonary valved homografts combined with PTFE tube grafts for now 16 years. Methods: In this report, we review our technique in detail and describe any changes that have occurred over the years. We provide detailed illustrations of our preferred surgical technique, report outcome data, and compare it to the other conduit options available. Results: Between 2006 and 2015, 130 stage I Norwood procedures were performed at our institution, 100 of them using valved conduits. Our technique is described and illustrated in detail. Early mortality was 15%. Postoperative percutaneous intervention on the conduit was required in 29% of cases. Conclusions: While a randomized trial comparing different valved conduits is lacking, we believe a composite conduit made from homograft aortic or pulmonary valves and PTFE tube grafts is an excellent choice in stage I Norwood procedure.