Ascending Aortic Slide for Interrupted Aortic Arch Repair

Abstract

Interrupted aortic arch (IAA) often presents with a wide gap between the proximal and distal portions of the arch which challenge a tension-free anastomosis, potentially increasing the risk for residual or recurrent arch obstruction, and left main bronchial compression. When possible, to preserve potential for growth of the repair, native tissue-to-tissue reconstruction is always preferred. Accordingly, rather than forcing a direct anastomosis with native tissue under tension or needing an interposition graft, the ascending aortic slide is an alternative useful technique to repair interrupted aortic arch in neonates and infants with difficult anatomy. Using a bridging flap of native tissue from the split ascending aorta and completion with patch material to fill in the lesser arch curvature, it has successfully been used in nine babies for bi-ventricular repair and uni-ventricular palliation with satisfactory results, and potential for growth. Interrupted aortic arch (IAA) often presents with a wide gap between the proximal and distal portions of the arch which challenge a tension-free anastomosis, potentially increasing the risk for residual or recurrent arch obstruction, and left main bronchial compression. When possible, to preserve potential for growth of the repair, native tissue-to-tissue reconstruction is always preferred. Accordingly, rather than forcing a direct anastomosis with native tissue under tension or needing an interposition graft, the ascending aortic slide is an alternative useful technique to repair interrupted aortic arch in neonates and infants with difficult anatomy. Using a bridging flap of native tissue from the split ascending aorta and completion with patch material to fill in the lesser arch curvature, it has successfully been used in nine babies for bi-ventricular repair and uni-ventricular palliation with satisfactory results, and potential for growth. Commentary: Sometimes, the Bench Players Are Your Most Valuable PlayersOperative Techniques in Thoracic and Cardiovascular SurgeryVol. 26Issue 3PreviewIn the current issue of the Operative Techniques Journal, Dodge-Khatami and Meyer describe their strategy for repair of interrupted aortic arch using the ascending aortic slide technique to bridge the gap between the interrupted arch segments. In their technique, the medial ascending aorta is split longitudinally in half starting from the sinotubular junction up to the arch origin. This ascending aorta flap is then rotated leftward and posteriorly and used as a posterior bridge of native tissue to connect the proximal and distal parts of the interruption. Full-Text PDF