Significance of clamping distance in bovine and normal aortic arch patients

Abstract

Bovine aortic arch is an anatomical variant in which the innominate and left common carotid arteries share a common origin. Coarctation of the aorta is a congenital heart defect characterized by narrowing of the aortic arch. Resection with extended end-to-end anastomosis through left thoracotomy, the usual preferred approach for coarctation repair, requires the placement of a proximal clamp just distal to the innominate artery and a distal clamp on the descending aorta. The clamping distance between the proximal clamp and the coarctation represents the length of vessel available for reconstructing the aorta. The goal of this study is to determine if bovine aortic arch anatomy affects clamping distance.Five hundred and fifty-four computed tomography scans performed on infants at our institution between 2012 and 2017 were analyzed. One hundred and sixty-nine scans met inclusion criteria. Fifty-eight exhibited bovine arch anatomy. Clamping distances were measured using multiplanar reconstruction. Clamping distances were indexed to body surface area to yield clamping index.The mean clamping distance was significantly shorter in bovine arch patients than in normal arch patients (p = 1.57 × 10−10). The mean clamping index was also significantly shorter in bovine arch patients (p = 0.0000014).This study demonstrates significantly shorter clamping indices in patients with bovine arch. Adequate clamping distance is required for a successful repair. Therefore, repair via lateral thoracotomy may not be ideal in bovine arch patients and adverse outcomes may be more likely. These patients may benefit from repair through median sternotomy.