Abstract：
Background: Postoperative restenosis of the aortic arch after the Norwood procedure is still an important complication that significantly affects surgical outcomes. The rarity of the Norwood procedure for atypical aortic morphology means appropriate arch reconstruction methods and postoperative complications are still unknown. This study aimed to assess the rate of arch reintervention and clinical outcomes after the Norwood procedure for atypical aortic arch. Methods: This retrospective single-center study was conducted between 2001 and 2022. Sixteen patients were identified, eight with a right aortic arch, five with transposition of the great arteries, one with a right aortic arch and transposition of the great arteries, and two with a large tortuous patent ductus arteriosus connected to the opposite side of the descending aorta. We selected and performed four different surgical techniques depending on each aortic arch morphology. Results: Except for one case, autologous tissue-only arch reconstruction was possible. There was one operative death and four late deaths. Overall, no patients required any surgical or catheter-based reintervention for the aortic arch. On the other hand, left pulmonary artery stenosis due to a narrow subaortic space was found in two patients. Conclusions: The Norwood procedure for atypical aortic arch was performed with good results by choosing the appropriate technique for each morphology. On the other hand, pulmonary artery stenosis is likely to occur especially in the transposition of the great arteries group. Therefore, careful surgical method selection or further improvement of the technique that allows retroaortic space should be considered.
摘要：
背景：Norwood手术后主动脉弓再狭窄仍然是重要的并发症，显着影响手术效果。非典型主动脉形态的Norwood手术的稀有性意味着适当的弓重建方法和术后并发症仍然未知。本研究旨在评估诺伍德手术治疗非典型主动脉弓后的弓再干预率和临床结果。方法：这项回顾性单中心研究于2001年至2022年进行。确定了16名患者，八位右主动脉弓，五个大动脉移位，一个右主动脉弓和大动脉转位，和两个有一个大的弯曲动脉导管未闭连接到降主动脉的另一侧。我们根据每个主动脉弓形态选择并执行了四种不同的手术技术。结果:除一例外,自体仅组织的牙弓重建是可能的。有1例手术死亡和4例晚期死亡。总的来说,没有患者需要对主动脉弓进行任何手术或导管再介入治疗.另一方面,在两名患者中发现了由于狭窄的主动脉下间隙引起的左肺动脉狭窄。结论：通过为每种形态选择合适的技术，对非典型主动脉弓进行Norwood手术效果良好。另一方面,尤其在大动脉转位组可能发生肺动脉狭窄。因此,应考虑仔细选择手术方法或进一步改进允许主动脉后间隙的技术.
