Results of correction of coarctation with hypoplasia of the aortic arch: “ascending sliding” against plasty of the aortic arch with a patch from the pulmonary homograph

Abstract

The main complications in the long-term period in children after the elimination of obstructive pathology of the aortic arch are arterial hypertension and recoarctation of the aorta. It is possible that persistent arterial hypertension is associated with the architectonics of the aortic arch and the nature of blood flow in it.Aim: To evaluate the immediate and long-term results after reconstruction of the aortic arch in conditions of artificial circulation by two methods: aortoplasty by “ascending sliding” (technique with native tissues) and aortoplasty using a patch of pulmonary homograft (technique using foreign material).Materials and Methods. In the presented single-center, pilot, prospective randomized study, the results of surgical treatment of coarctation with hypoplasia of the aortic arch in conditions of artificial circulation were assessed. According to the study design, depending on the method of correction of aortic coarctation, all patients were divided into two groups: aortoplasty by the “ascending sliding” method (30 patients); aortoplasty with a patch from a pulmonary homograph (30 patients).Results. There was no lethality in the hospital period. In the early postoperative period, the compression of the bronchi or trachea in the “ascending sliding” group was 20% versus 0% in the aortoplasty group using a patch from a pulmonary homograph. Recoarctation of the aorta in the aortoplasty group using a patch from a pulmonary homograph was 30%, while in the “ascending sliding” group there was no recoarctation. Arterial hypertension in the “ascending sliding” group was 13.3%, and in the aortoplasty group, using a patch from a pulmonary homograph was 56.6%.Conclusion. Patients after “ascending sliding” correction have a higher chance of bronchial and tracheal compression in the early postoperative period, while patients after correction by aortoplasty with a patch from a pulmonary homograph had a higher incidence of hypertension and aortic recoartcation.