Aortic arch repair with extended end-to-side anastomosis in neonates and infants with transverse arch hypoplasia

Aortic arch repair in neonates and infants

Authors

Keywords:

aortic arch, aortic coarctation, congenital heart defects, infant, surgery

Abstract

Background/Aim: The use of patches to repair the aortic arch is believed to have a positive effect on long-term morbidity. In this study, perioperative and follow-up data of patients who underwent transverse arch repair with a patch were compared with the data of patients who underwent end-to-end anastomosis (ESA).

Methods: In this retrospective cohort study, the data of 27 patients (including 18 newborns) who underwent aortic arch repair at the Gazi Yasargil Education and Research Hospital between January 2018 and April 2023 were analyzed. The inclusion criteria included a diagnosis of proximal and distal transverse aortic arch hypoplasia, an age younger than 12 months of age, and the completion of aortic arch repair using cardiopulmonary bypass. Patients who underwent recoarctation repair due to residual obstruction, patients with single ventricular physiology, and patients who underwent aortic arch repair via a lateral thoracotomy without undergoing cardiopulmonary bypass were excluded from the study. The patients were divided into two groups. Group 1 included individuals who underwent aortic anterior wall expansion with autologous pericardium in addition to ESA; Group 2 included patients who underwent ESA only.

Results: The median age of the patients was 21 days (range: 6–365 days), and the median body weight of the cohort was 3.5 kilograms (range: 2.4–8.9 kilograms). Enlargement with autologous pericardial patch was applied to 11 patients (40.7%). Surgical procedures performed in addition to arch repair included eight ventricular septal defect closures, six instances of pulmonary banding, three atrial septal defect closures, and one subvalvular pulmonary stenosis repair. The in-hospital mortality rate was 11.1% (n=3). Those three patients died due to sepsis. The median follow-up period was 152 days (range: 10–1316 days). Recoarctation requiring re-intervention did not occur in any of the studied patients. The antegrade selective cerebral perfusion time was statistically significantly longer in patients who underwent aortic arch repair using a patch (P=0.03).

Conclusion: Repair of the arch with a patch may contribute to a reduction in long-term mortality and morbidity. However, there is a need for more comprehensive and long-term follow-up studies to verify these findings.

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References

Poncelet AJ, Henkens A, Sluysmans T, Moniotte S, de Beko G, Momeni M, et al. Distal aortic arch hypoplasia and coarctation repair: a tailored enlargement technique. World J Pediatr Congenit Heart Surg. 2018;9:496-503. DOI: https://doi.org/10.1177/2150135118780611

Murtuza B, Alsoufi B. Current readings on surgery for the neonate with hypoplastic aortic arch. Semin Thoracic Surg. 2017;29:479-85. DOI: https://doi.org/10.1053/j.semtcvs.2017.11.004

Gray WH, Wells WJ, Starnes VA, Kumar SR. Arch augmentation via median sternotomy for coarctation of aorta with proximal arch hypoplasia. Ann Thorac Surg. 2018;106(4):1214-9. DOI: https://doi.org/10.1016/j.athoracsur.2018.04.025

Bernabei M, Margaryan R, Arcieri L, Bianchi G, Pak V, Murzi B. Aortic arch reconstruction in newborns with an autologous pericardial patch: contemporary results. Interact Cardiovasc Thorac Surg. 2013;16(3):282-5. DOI: https://doi.org/10.1093/icvts/ivs510

Wen S, Cen J, Chen J, Xu G, He B, Teng Y, et al. The application of autologous pulmonary artery in surgical correction of complicated aortic arch anomaly. J Thorac Dis. 2016;8(11):3301-6. DOI: https://doi.org/10.21037/jtd.2016.11.43

Brown JW, Rodefeld MD, Ruzmetov M. Transverse aortic arch obstruction: when to go from the front. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2009;66-9.doi: 10.1053/j.pcsu.2009.01.024. DOI: https://doi.org/10.1053/j.pcsu.2009.01.024

Walhout RJ, Lekkerkerker JC, Oron GH, Hitchcock FJ, Meijboom EJ, Bennink GB. Comparison of polytetrafluoroethylene patch aortoplasty and end-to-end anastomosis for coarctation of the aorta. J Thorac Cardiovasc Surg. 2003;126:521-8. DOI: https://doi.org/10.1016/S0022-5223(03)00030-8

Zannini L, Gargiulo G, Albanese SB, Santorelli MC, Frascaroli G, Picchio FM, et al. Aortic coarctation with hypoplastic arch in neonates: a spectrum of anatomic lesions requiring different surgical options. Ann Thorac Surg. 1993;56(2):288-94. DOI: https://doi.org/10.1016/0003-4975(93)91162-G

Pettersen MD, Du W, Skeens ME, Humes RA. Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr. 2008;21(8):922-34. DOI: https://doi.org/10.1016/j.echo.2008.02.006

Turek JW, Conway BD, Cavanaugh NB, Meyer AM, Aldoss O, Reinking BE, et al. Bovine arch anatomy influences recoarctation rates in the era of the extended end-to-end anastomosis. J Thorac Cardiovasc Surg. 2018;155(3):1178-83. DOI: https://doi.org/10.1016/j.jtcvs.2017.10.055

Lee MG, Brink J, Galati JC, Rakhra SS, Konstantinov IE, Cheung MM, et al. End‑to‑side repair for aortic arch lesions offers excellent chances to reach adulthood without reoperation. Ann Thorac Surg. 2014;98(4):1405-11. DOI: https://doi.org/10.1016/j.athoracsur.2014.05.007

Kaushal S, Backer CL, Patel JN, Patel SK, Walker BL, Weigel TJ, et al. Coarctation of the aorta: midterm outcomes of resection with extended end-to-end anastomosis. Ann Thorac Surg. 2009;88(6):1932-8. DOI: https://doi.org/10.1016/j.athoracsur.2009.08.035

McElhinney DB, Yang SG, Hogarty AN, Rychik J, Gleason MM, Zachary CH, et al. Recurrent arch obstruction after repair of isolated coarctation of the aorta in neonates and young infants: is low weight a risk factor? J Thorac Cardiovasc Surg. 2001;122(5):883-90. DOI: https://doi.org/10.1067/mtc.2001.116316

Wright GE, Nowak CA, Goldberg CS, Ohye RG, Bove EL, Rocchini AP. Extended resection and end-to-end anastomosis for aortic coarctation in infants: results of a tailored surgical approach. Ann Thorac Surg. 2005;80(4):1453-9. DOI: https://doi.org/10.1016/j.athoracsur.2005.04.002

Elgamal MA, McKenzie ED, Fraser CD Jr. Aortic arch advancement: the optimal one-stage approach for surgical management of neonatal coarctation with arch hypoplasia. Ann Thorac Surg. 2002;73(4):1267-72. DOI: https://doi.org/10.1016/S0003-4975(01)03622-0

Dharmapuram AK, Ramadoss N, Verma S, Vejendla G, Ivatury RM. Early outcomes of modification of end to side repair of coarctation of aorta with arch hypoplasia in neonates and infants. Ann Pediatr Cardiol. 2018;11(3):267-74. DOI: https://doi.org/10.4103/apc.APC_5_18

Liu JY, Jones B, Cheung MM, Galati JC, Koleff J, Konstantinov IE, et al. Favourable anatomy after end-to-side repair of interrupted aortic arch. Heart Lung Circ. 2014;23(3):256-64. DOI: https://doi.org/10.1016/j.hlc.2013.08.006

Rakhra SS, Lee M, Iyengar AJ, Wheaton GR, Grigg L, Konstantinov IE, et al. Poor outcomes after surgery for coarctation repair with hypoplastic arch warrants more extensive initial surgery and close long-term follow-up. Interact Cardiovasc Thorac Surg. 2013;16(1):31-6. DOI: https://doi.org/10.1093/icvts/ivs301

Mery CM, Guzmán-Pruneda FA, Carberry KE, Watrin CH, McChesney GR, Chan JG, et al. Aortic arch advancement for aortic coarctation and hypoplastic aortic arch in neonates and infants. Ann Thorac Surg. 2014;98(2):625-33; discussion 633. DOI: https://doi.org/10.1016/j.athoracsur.2014.04.051

Seo DM, Park J, Goo HW, Kim YH, Ko JK, Jhang WK. Surgical modification for preventing a gothic arch after aortic arch repair without the use of foreign material. Interact Cardiovasc Thorac Surg. 2015;20(4):504-9. DOI: https://doi.org/10.1093/icvts/ivu442

Li C, Ma J, Yan Y, Chen Ho, Shi G, Chen Hu, et al. Surgical options for proximal and distal transverse arch hypoplasia in infants with coarctation. Transl Pediatr. 2022;11(3):330-9. DOI: https://doi.org/10.21037/tp-21-557

Rudolph AM, Heymann MA, Spitznas U. Hemodynamic considerations in the development of narrowing of the aorta. Am J Cardiol. 1972;30(5):514-25. DOI: https://doi.org/10.1016/0002-9149(72)90042-2

Conte S, Lacour-Gayet F, Serraf A, Sousa-Uva M, Bruniaux J, Touchot A, et al. Surgical management of neonatal coarctation. J Thorac Cardiovasc Surg. 1995;109(4):663-74, discussion 74-5. DOI: https://doi.org/10.1016/S0022-5223(95)70347-0

Gaynor JW, Wernovsky G, Rychik J, Rome JJ, DeCampli WM, Spray TL. Outcome following single-stage repair of coarctation with ventricular septal defect. Eur J Cardiothorac Surg. 2000;18(1):62-7. DOI: https://doi.org/10.1016/S1010-7940(00)00440-1

Planche C, Serraf A, Comas JV, Lacout-Gayet F, Bruniaux J, Touchot A. Anatomic repair of transposition of great arteries with ventricular septal defect and aortic arch obstruction. One-stage versus two-stage procedure. J Thorac Cardiovasc Surg. 1993;105(5):925-33. DOI: https://doi.org/10.1016/S0022-5223(19)34167-4

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Published

2023-08-28

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Research Article

How to Cite

1.
Doyurgan O, Balık H. Aortic arch repair with extended end-to-side anastomosis in neonates and infants with transverse arch hypoplasia: Aortic arch repair in neonates and infants. J Surg Med [Internet]. 2023 Aug. 28 [cited 2024 Feb. 22];7(8):504-8. Available from: https://jsurgmed.com/article/view/7905