Transcatheter interventions post Norwood/Sano procedures: single-centre experience

Transcatheter interventions are becoming increasingly used to address postoperative residual lesions after Norwood procedure with Sano shunt.

This is a single-centre retrospective review of the outcome of all cases with Sano shunt at our institution over a 6-years period (2017-2023) who underwent transcatheter interventions.

Thirteen out of the total 34 patients (38%) needed transcatheter interventions. The most common interventions were left pulmonary artery balloon angioplasty (n = 6), balloon angioplasty of aortic recoarctation (n = 6), and Sano shunt stenting (n = 5). Left pulmonary artery size improved from 3 [IQR; 2-5] mm to 4.9 [IQR; 2.7-7.3] mm post-intervention (p-value = 0.068), and gradient from 28 [IQR; 25-33] mmHg to 11 [IQR; 10-13] mmHg (p-value = 0.109). Balloon angioplasty of aortic recoarctation improved vessel size from 6.7 [IQR; 4-9] mm to 9.5 [IQR; 7-13] mm (p-value = 0.066), and reduced peak-to-peak gradient from 22.3 [IQR; 10-39] mmHg to 7.6 [IQR; 4-14] mmHg (p-value = 0.109). Finally, Stenting of Sano shunt resulted in increased shunt size from 3.4 [IQR; 3.1-3.6] mm to 5.5 [IQR; 4.2-6] mm (p-value = 0.066), and improvement of the oxygen saturation from 71.3 [IQR; 69-74] % to 85.3 [IQR; 83-89] % (p-value = 0.066). There was one procedure-related death.

Transcatheter intervention for patients post Sano shunt is feasible with good results, improving haemodynamics and oxygenation of the patients and thereby allowing them to come on the proper time for the second stage palliation.