Intervention for Arch Obstruction After Norwood: Prevalence, Associated Factors, and Practice Variability

Aortic arch obstruction after Norwood is common and causes mortality. We analyzed arch reinterventions after Norwood to determine associated factors and association with mortality. From 2005-2017, 593 neonates underwent a Norwood procedure. Multivariable parametric models, including a modulated renewal analysis, were performed. There were 218 arch reinterventions in 146 patients (25%) at median age 4.3 months. Factors associated with reduced risk for arch reintervention included: interdigitation of the distal aortic anastomosis and prior surgical arch reintervention. Factors associated with increased risk for arch reintervention included: development of tricuspid valve regurgitation and right ventricular dysfunction and transcatheter reintervention. Non-significant variables included: shunt type, coarctectomy, and pre-Norwood aortic measurements. Reintervention was not associated with increased mortality. There was wide institutional variation in arch reintervention practices. Serial surveillance for arch obstruction, including changes in right ventricular function and tricuspid valve regurgitation, is recommended after Norwood to enable prompt treatment of post-Norwood arch obstruction.M.Sc