Advances of surgical and perfusion techniques for aortic arch hypoplasia

Abstract

Currently the anatomic criteria for defining aortic arch hypoplasia have remained controversial. The major circumstances are proximal transverse aortic arch of <60% of ascending aortic diameter, a distal transverse aortic arch of <50% of ascending aortic diameter, an isthmus <40%, a diameter of transverse arch <50% of distal ascending aortic diameter or a diameter of transverse arch <50% of distal descending aortic diameter. One common rule-of-thumb is a diameter of transverse arch <0.1 mm for each 1 kg body weight. z-score: the diameter of each segment < two standard deviations below average, z-score <2.0. There is a wide spectrum of aortic arch hypoplasia. And each patient has different anatomic and physiological characteristics. Aortic arch hypoplasia usually occurs in association with intra-cardiac anomalies. And its rates of complication, reintervention and mortality are unsatisfactory. The major surgical techniques are extended end-to-end anastomosis, subclavian flap approach, end-to-side anastomosis and patch aortoplasty. And the major perfusion techniques include deep hypothermic circuitry arrest and selective cerebral perfusion. A proper selection of surgical approaches and perfusion techniques may improve the outcomes. According to the specific status of aortic arch hypoplasia patient, individualized treatment is needed. Here we make a review of progress of surgery and perfusion technique in aortic arch hypoplasia. Key words: Aortic arch hypoplasia; Perfusion