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

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.

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

2021 ◽  
Vol 12 (4) ◽  
pp. 487-491
Author(s):  
Ingrid M. van Beynum ◽  
Serife Kurul ◽  
Thomas Krasemann ◽  
Michiel Dalinghaus ◽  
Pieter van de Woestijne ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Important Determinant ◽  
Primary Repair ◽  
First Year ◽  
Aortic Arch Reconstruction ◽  
Study Population ◽  
Aortic Arch Repair ◽  
Neonates And Infants ◽  
Arch Reconstruction ◽  
First Year Of Life

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.

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

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.

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

2013 ◽  
Vol 24 (3) ◽  
pp. 559-562 ◽  
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.

scholarly journals The analyze of neurological complications after aortic arch reconstruction in patients with proximal aortic dissection

2015 ◽  
Vol 17 (2) ◽  
pp. 35
Author(s):  
A. M. Chernyavskiy ◽  
S. A. Alsov ◽  
M. M. Lyashenko ◽  
D. A. Sirota ◽  
D. S. Khvan ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Neurological Complications ◽  
Pathological Process ◽  
Arterial Lesions ◽  
Aortic Arch Reconstruction ◽  
Almost All ◽  
Arch Reconstruction ◽  
The Brain

The article analyzes the neurological complications after interventions on the ascending aorta and the aortic arch in dissection I type by De Bakey. Group of authors investigated over a decade of experience in surgery of aortic dissection in both acute and chronic. Authors estimated the incidence of neurological complications after surgical intervention in 124 patients in the early post-operative and long term period. It were studied both qualitative measures (methods of reconstruction of the aortic arch, type of cerebral perfusion, the etiology of the pathological process, comorbidities) and quantitative (the duration of the different stages of surgery, age, height, weight). The analysis revealed that almost all cases of strokes were observed in the older age group and were associated with concomitant occlusive-stenotic arterial lesions caused by Takayasu's syndrome and atherosclerosis, as well as a set of related diseases. Increase in the number of strokes contribute to more complex, and therefore more time-consuming intervention types of reconstruction of the aortic arch. Antegrade perfusion of the brain, to our knowledge, did not have statistically significant advantages over retrograde perfusion or hypothermic circulatory arrest of the brain.

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