Abstract
Summary Objectives Various surgical strategies have been reported for the treatment of aortic coarctation with hypoplastic aortic arch, including simple resection and end-to-end anastomosis as well as various forms of patch augmentation. These techniques are limited by inadequate relief of arch obstruction and use of patch material predisposed to recurrent obstruction or aneurysm formation. We report our experience with autologous aortic arch reconstruction in isolated and combined lesions, a technique that relieves even complex forms of arch reconstruction without patch material. Methods We retrospectively analyzed our institutional experience with autologous aortic arch reconstruction in isolated and combined cardiac lesions from November 2009 to December 2016. Study endpoints were procedural success, incidence of procedure-related complications, need for re-interventions, and survival. Results In total, 54 patients underwent total autologous aortic arch reconstruction during the study period. Thereof, 13 (24%) had isolated arch obstruction and 41 (76%) had combined cardiac lesions. The majority of procedures were performed in the neonatal period (72%), median age was 8 days (range: 1 day to 4.3 years). Body weight ranged from 2.2 to 16.5 kg (median: 3.7 kg). There was one (1.9%) procedure-related early reoperation for bronchial obstruction. No repeat interventions (dilatation or re-operation) were observed. One patient with syndromic disease died on postoperative day 20 due to sepsis (1.9% in-hospital mortality rate). No late deaths were observed. Median follow-up was 23 months. Conclusion Autologous aortic arch reconstruction is a safe and effective surgical technique for the treatment of aortic arch obstruction in isolated and complex cardiac lesions. It is associated with an extremely low re-intervention rate and a low overall complication rate.
Highlights
Aortic arch hypoplasia is a frequent finding in patients with isolated aortic coarctation as well as in combined cardiac lesions
Various surgical techniques have been developed for the treatment of aortic arch hypoplasia in patients with aortic coarctation and combined cardiac lesions over the Autologous aortic arch reconstruction in isolated and combined cardiac lesions 165 original article years
Aortic arch advancement with extended end-to-side anastomosis via a median sternotomy has been introduced to address the shortcomings of end-to-end anastomosis and patch augmentation [9,10,11]
Summary
Aortic arch hypoplasia is a frequent finding in patients with isolated aortic coarctation as well as in combined cardiac lesions. Autologous aortic arch reconstruction in isolated and combined cardiac lesions 165 original article years These include resection and end-to-end anastomosis [1, 2], subclavian flap technique [3], as well as various forms of patch augmentation [4, 5]. Aortic arch advancement with extended end-to-side anastomosis via a median sternotomy has been introduced to address the shortcomings of end-to-end anastomosis and patch augmentation [9,10,11] This technique allows for complete relief of arch obstruction in isolated coarctation as well as in combined cardiac lesions without introduction of patch material into the aortic arch. Study endpoints were procedural success, perioperative adverse events, and long-term survival as well as recurrence of arch obstruction
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