Reconstruction of the Aortic Arch in Neonates and Infants: The Importance of Patch Material

Objectives: Restenosis after aortic arch reconstruction is a known complication in neonates and infants. Homograft is the most commonly used patch material for aortic arch reconstructions in our center. Since 2014, tissue-engineered bovine pericardium (CardioCel) has been used as an alternative. The aim of our study was to determine whether the choice of material affected the development of restenosis in these patients. Methods: Data of all neonates and infants who underwent aortic arch reconstruction with the use of any patch material between 2005 and 2016 were analyzed. Restenosis was defined by the need for reintervention, either percutaneous or surgical. Results: Forty-one patients underwent aortic arch repair. Excluding the 30-day mortality, 36 patients represented the study population. At primary repair, the aortic arch was reconstructed with homograft (n = 26) or CardioCel (n = 10). Restenosis was documented during the first year of life in 13 patients: Six (23%) patients in the homograft group and seven (70%) patients in the CardioCel group ( P = .01). In the homograft group, the median time from operation to first intervention for restenosis was 22.0 (range: 14-32) weeks, as compared to 14.0 (range: 7-21) weeks in the CardioCel group ( P = .04). Conclusion: We conclude that choice of patch material is likely to be an important determinant for the risk of restenosis needing reintervention following reconstruction of the aortic arch in neonates and infants.

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Results of aortic arch reconstruction in neonates and infants

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0029-1191435 ◽

2009 ◽

Vol 56 (S 01) ◽

Author(s):

L Ben Mime ◽

M Emmel ◽

N Sreeram ◽

K Brockmeier ◽

G Bennink ◽

...

Keyword(s):

Aortic Arch ◽

Aortic Arch Reconstruction ◽

Neonates And Infants ◽

Arch Reconstruction

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Contemporary outcomes of aortic arch hypoplasia and coarctation repair in a tertiary paediatric cardiac surgery centre

Cardiology in the Young ◽

10.1017/s1047951121003747 ◽

2021 ◽

pp. 1-6

Author(s):

Amr Ashry ◽

Amer Harky ◽

Abdulla Tarmahomed ◽

Christopher Ugwu ◽

Heba M. Mohammed ◽

...

Keyword(s):

Aortic Arch ◽

Circulatory Arrest ◽

Recurrent Laryngeal Nerve Injury ◽

Coarctation Repair ◽

Aortic Arch Reconstruction ◽

Retrospective Data Collection ◽

Laryngeal Nerve Injury ◽

Neonates And Infants ◽

Arch Reconstruction ◽

Aortic Arch Hypoplasia

Abstract Objectives: There are several studies reporting the outcomes of hypoplastic aortic arch and aortic coarctation repair with combination of techniques. However, only few studies reported of aortic arch and coarctation repair using a homograft patch through sternotomy and circulatory arrest with retrograde cerebral perfusion. We report our experience and outcomes of this cohort of neonates and infants. Methods: We performed retrospective data collection for all neonates and infants who underwent aortic arch reconstruction between 2015 and 2020 at our institute. Data are presented as median and inter-quartile range (IQR). Results: The cohort included 76 patients: 49 were males (64.5%). Median age at operation was 16 days (IQR 9–43.25 days). Median weight was 3.5 kg (IQR 3.10–4 kg). There was no 30 days mortality. Three patients died in hospital after 30 days (3.95%), neurological adverse events occurred in only one patient (1.32%) and recurrent laryngeal nerve injury was noted in four patients (5.26%). Only three patients required the support of extracorporeal membrane oxygenation (ECMO) with a median ECMO run of 4 days. Median follow-up was 35 months (IQR 18.9–46.4 months); 5 years survival was 93.42% (n = 71). The rate of re-intervention on the aortic arch was 9.21% (n = 7). Conclusion: Our experience shows excellent outcomes in repairing aortic arch hypoplasia with homograft patch under moderate to deep hypothermia with low in-hospital and 5 years mortality rates.

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Aortic arch augmentation using a pulmonary artery autograft patch and a reversed left subclavian artery flap for an interrupted aortic arch type B complex

Cardiology in the Young ◽

10.1017/s1047951113000899 ◽

2013 ◽

Vol 24 (3) ◽

pp. 559-562 ◽

Cited By ~ 6

Author(s):

Tomomi Hasegawa ◽

Yoshihiro Oshima ◽

Tasuku Kadowaki

Keyword(s):

Pulmonary Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Interrupted Aortic Arch ◽

Type B ◽

Aortic Arch Reconstruction ◽

Aortic Arch Repair ◽

Arch Reconstruction ◽

Bronchial Compression

AbstractAdequate arch augmentation for interrupted aortic arch repair is quite important to avoid post-operative recoarctation and bronchial compression. We describe here two successful cases of aortic arch reconstruction using autologous materials such as a pulmonary artery patch and a reversed left subclavian artery flap in infants with an interrupted aortic arch type B complex.

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Technical features of Norwood procedure as the most important factor, affecting the outcome of treatment of single-ventricle patients with obstructed systemic output

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2019-178-1-11-16 ◽

2019 ◽

Vol 178 (1) ◽

pp. 11-16

Author(s):

A. A. Avramenko ◽

S. M. Khokhlunov

Keyword(s):

Aortic Arch ◽

Single Ventricle ◽

Circulatory Arrest ◽

Regional Perfusion ◽

Results Of Treatment ◽

Aortic Arch Reconstruction ◽

Aortic Arch Repair ◽

Technical Features ◽

Aortic Obstruction ◽

Arch Reconstruction

Theobjectivewas to improveNorwood procedure outcomes by discovering optimal surgical technique and perfusion strategy.Material and methods.Results of treatment of single-ventricle patients with obstructed systemic output during 2005–2017 were analyzed (64 patients). 61 patients underwentNorwood procedure. Outcomes were compared between groups with different perfusion strategies and different methods of aortic arch reconstruction.Results.Mortality in two-regional perfusion group was 23 %, in group of circulatory arrest and selective cerebral perfusion – 53 % (p=0.020). Early aortic obstruction was a risk factor of mortality (p=0.024). Median time of freedom from obstruction of aorta was 3 days in xenopericardium group, 76 days in pulmonary allograft group, and 390 days in isthmus resection and pulmonary allograft group (p=0.002).Conclusion.Two-regional perfusion and aortic arch repair with pulmonary allograft patch after isthmus resection are our methods of choice as they allow to reduce the incidence of complications afterNorwood procedure.

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Aortic Arch Reconstruction Using “Autologous Pulmonary Artery Patch” as an Interposition Patch Plasty in Interrupted Aortic Arch and Ventricular Septal Defect

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1571575 ◽

2016 ◽

Vol 64 (S 01) ◽

Author(s):

U. Yörüker ◽

C. Yerebakan ◽

H. Elmontaser ◽

K. Valeske ◽

M. Müller ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Pulmonary Artery ◽

Aortic Arch ◽

Septal Defect ◽

Interrupted Aortic Arch ◽

Aortic Arch Reconstruction ◽

Arch Reconstruction ◽

Patch Plasty

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Gastrostomy Tube Placement in Neonates Undergoing Congenital Heart Surgery: A Novel Assessment for Improving Utilization and Timing of Placement

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/21501351211003103 ◽

2021 ◽

Vol 12 (4) ◽

pp. 480-486

Author(s):

Kevin M. Beers ◽

Aaron Bettenhausen ◽

Thomas J. Prihoda ◽

John H. Calhoon ◽

S. Adil Husain

Keyword(s):

Length Of Stay ◽

Aortic Arch ◽

Congenital Heart ◽

Gastrostomy Tube ◽

Tube Placement ◽

Genetic Syndrome ◽

Delayed Sternal Closure ◽

Aortic Arch Reconstruction ◽

Gastrostomy Tube Placement ◽

Arch Reconstruction

Background: Neonates undergoing congenital heart defect repair require optimized nutritional support in the perioperative period. Utilization of a gastrostomy tube is not infrequent, yet optimal timing for placement is ill-defined. The objective of this study was to identify characteristics of patients whose postoperative course included gastrostomy tube placement to facilitate supplemental tube feeding following neonatal repair of congenital heart defects. Methods: A single-institution, retrospective chart review identified 64 consecutive neonates who underwent cardiac operations from 2012 to 2016. Perioperative variables were evaluated for significance in relation to gastrostomy tube placement. Results: A total of 27 (42%) underwent gastrostomy tube placement. Diagnosis of a genetic syndrome was associated with the likelihood of placement of gastrostomy tube ( P = .032), as were patients with single ventricle physiology ( P = .0013) compared to those felt to be amenable to eventual biventricular repair. Aortic arch reconstruction ( P = .029), as well as the need for delayed sternal closure ( P = .05), was associated with increased frequency of gastrostomy tube placement. Postoperative outcomes including the number of days intubated ( P = .0026) and the presence of significant dysphagia ( P = .0034) were associated with gastrostomy placement. Additionally, genetic syndrome ( P = .003), aortic arch reconstruction ( P = .01), and postoperative intubation duration ( P = .0024) correlated with increased length of stay, where increased length of stay was associated with gastrostomy tube placement ( P = .0004). Discussion: Patient characteristics that were associated with a high likelihood of eventual gastrostomy placement were identified in this study. Early recognition of such characteristics in future patients may allow for reduced time to gastrostomy tube placement, which in turn may improve perioperative growth and outcomes.

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