Valved Sano Conduit During the Norwood Procedure: A Contemporary Review of Early Outcomes, Reintervention Burden, and Pulmonary Artery Growth

BACKGROUND The valved Sano (VS) right ventricle-to-pulmonary artery (RV-PA) shunt was developed to eliminate conduit regurgitation and thereby decrease volume load on the single right ventricle (RV) after the Norwood procedure. By reducing diastolic backflow, VS may limit tricuspid regurgitation (TR) and preserve RV function. Additional theoretical advantages include facilitated postoperative recovery and improved pulmonary artery (PA) growth. Despite compelling physiology, available evidence remains limited and largely retrospective. METHODS We describe the postoperative course of a low-weight neonate with hypoplastic left heart syndrome (HLHS) who underwent a Norwood procedure using a VS, and we review published literature addressing early outcomes, reintervention burden, late survival, and PA growth. RESULTS Use of a VS can be associated with improved early physiologic recovery, lower postoperative lactate, faster diuresis and enteral advancement, and better early RV function. Short-term survival appears equivalent to the non-valved Sano (NVS). Interstage reinterventions remain frequent (40-60 % before stage II). Late survival beyond stage II is comparable to NVS. Femoral vein homograft (FVH)-based conduits may promote greater PA growth and reduce the need for PA augmentation, but findings vary across centers. Valve competence commonly decays within 3-6 months, resulting in conduit regurgitation. CONCLUSIONS VS conduits may facilitate early recovery and potentially favor PA growth when constructed with competent FVH segments, yet they have not demonstrated superior late survival or reduced reintervention burden. Larger multicenter studies are required to clarify optimal patient selection and long-term impact.