Aortic Arch Reconstruction in Neonates with Biventricular Morphology: Increased Risk for Development of Recoarctation by Use of Autologous Pericardium

Bechtold, Caroline; Purbojo, Ariawan; Schwitulla, Judith; Glöckler, Martin; Toka, Okan; Dittrich, Sven; Cesnjevar, Robert; Rüffer, André

doi:10.1055/s-0034-1396532

Cited by 18 publications

(15 citation statements)

References 15 publications

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“…6 Pericardial materials or arterial allografts may also be used in reconstruction of the aorta. 11 Bechtold et al 15 used various patch materials including autologous pericardium treated with 0.6% glutaraldehyde for 20 minutes, bovine pericardium and homograft patches. In their series, re-coarctation occurs in certain cases especially who received autologous pericardium during initial arch repair.…”

Section: Discussionmentioning

confidence: 99%

“…In their series, re-coarctation occurs in certain cases especially who received autologous pericardium during initial arch repair. 15 Bernabei et al 16 used gluteraldehyde-treated autologous pericardium in their cases for aortic arch repair, and they faced with re-stenosis in some of their cases. Their attempt was to balloon dilate the stenosed arches primarily; however, unsuccessful cases were surgically treated.…”

Section: Discussionmentioning

confidence: 99%

“…1 The residual aortic arch obstruction is not an uncommon pathology and ends up with requirement of the re-intervention in approximately 20% to 40% of the patients who receive aortic interruption repair. 1 Angioplasty may be considered in case of re-stenosis 6,15,16 ; however, the results in the literature reveal that the technique did not reduce the need for surgical reoperation. 1 Figure 3.…”

Section: Discussionmentioning

confidence: 99%

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Off-pump ascending aorta or aortic arch to descending aorta bypass with a pericardial roll for the treatment of critically ill infants with interrupted aortic arch

et al. 2020

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Aim: Standard surgical treatment of the interrupted aortic arch with the use of cardiopulmonary bypass is risky especially in critically ill babies. In this manuscript, we present the results of off-pump pericardial roll bypass for the treatment of aortic interruption. Material and methods: The technique was applied in nine critically ill infants between July 2011 and December 2019. Data were reviewed retrospectively. There were four girls and five boys. The types of the interruption were type B in six cases and type A in three babies. Additional cardiovascular anomalies were ventricular septal defect in all, atrial septal defect or patent foramen ovale in all, single-ventricle pathologies in two and bicuspid aortic valve in three cases. All the patients were in critical situations such as intubated, having symptoms of infection, congestive heart failure or ischaemia and malperfusion leading visceral organ dysfunction. Results: All patients underwent off-pump ascending aorta or aortic arch to descending aorta bypass with a pericardial roll. Post-operative early mortality occurred in one patient with severe mitral regurgitation due to cardio-septic shock. One patient who had single-ventricle pathology underwent bidirectional Glenn and was lost on the post-operative 26th day due to sepsis 2 years after operation. Two patients presented with dilatation of the pericardial tube 18 and 24 months after the operations and one underwent reconstruction of the neo-arch. The remaining patients are asymptomatic, active and within normal limits of body and mental growth. Conclusion: Treatment of interrupted aortic arch with a bypass with an autologous pericardial roll treated with gluteraldehyde without cardiopulmonary bypass seems a safe and reliable technique especially for the treatment of critically ill infants.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Off-pump ascending aorta or aortic arch to descending aorta bypass with a pericardial roll for the treatment of critically ill infants with interrupted aortic arch

et al. 2020

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“…There are several factors reported in the literature that are thought to cause restenosis. The effect of the surgical technique, patch material, and perfusion strategies on restenosis has been investigated by various authors (10,23,24). However, there is insufficient data about the effect of the perfusion strategy used on surgical quality and long-term mortality and reintervention.…”

Section: Discussionmentioning

confidence: 99%

Short- and mid-term outcomes of aortic arch reconstruction: Beating heart versus cardiac arrest

Ergün¹,

Onan²,

Yıldız³

et al. 2020

Preprint

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Objectives: We aimed to compare the short-and mid-term results of perfusion strategies used for arch reconstruction surgery. Material and Methods: One hundred and seventy-three consecutive patients who underwent aortic arch reconstruction surgery for transverse arcus hypoplasia between January 2011 and February 2020 were retrospectively analyzed. The patients were divided into two groups, as beating heart group and cardiac arrest group. Results: The cardiac arrest group comprised 60 (35%) patients and the remaining 113 (65%) patients were in the beating heart group. The median age of the patients was 30 (IQR 18-95) days. The incidences of acute renal failure and delayed sternal closure were higher in the cardiac arrest group (P = 0.05,P < 0.001 respectively). Balloon angioplasty was performed in 5 (2%) patients and reoperation was performed in 11 (6%) patients due to restenosis. There were no statistically significant differences between the two groups in terms of reoperation or reintervention rates (P = 0.44 and 0.34, respectively). Conclusions: Both strategies were associated with satisfactory mid-term prevention of reintervention and reoperation. Given the lower incidence of acute renal failure and delayed sternal closure in the postoperative period and similar mid-term outcomes, we believe that the beating heart strategy is preferable.

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“…[ 19 ] Compared to autologous pericardium, the autologous pulmonary artery patch has good elasticity, histocompatibility, growth potential, and high homology with the aortic wall. [ 20 21 ] According to the reported literature, no restenoses or aortic aneurysms occurred in the patients who underwent autologous pulmonary patch aortoplasty during midterm follow-up; the restenosis-free rate at 3 years after surgery was 100%. [ 9 22 ]…”

Section: Discussionmentioning

confidence: 99%

Coarctation of the Aorta with Aortic Arch Hypoplasia

Yan

et al. 2017

Chinese Medical Journal

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Background:Coarctation of the aorta (CoA) with aortic arch hypoplasia (AAH) is a relatively common congenital heart disease in clinical practice. Nonetheless, the corrective surgical technique for infants and children is a clinical problem that remains controversial. In this study, we sought to evaluate the surgical effects of aortic arch (AA) reconstruction with coarctation resection and aortoplasty with autologous pulmonary artery patch for infants and young children with CoA and AAH.Methods:Between January 2009 and December 2015, a total of 22 infants and young children with CoA and AAH who underwent coarctation resection and aortoplasty with autologous pulmonary artery patch were enrolled in this study. The median age of patients was 4.5 (Q1, Q3: 2.0, 14.0) months and the median body weight was 5.75 (Q1, Q3: 4.10, 9.38) kg. All patients were diagnosed with CoA and AAH, and concomitant cardiac anomalies were corrected in one stage. Perioperative and postoperative data were collected and analyzed using the paired sample t-test.Results:No perioperative deaths occurred. No residual obstruction was detected by echocardiography. The postoperative pressure difference across the repaired segment of CoA was 14.05 ± 4.26 mmHg (1 mmHg = 0.133 kPa), which was smaller than the preoperative pressure difference (48.30 ± 15.73 mmHg; t = −10.119, P < 0.001). The median follow-up time was 29.0 (Q1, Q3: 15.5, 57.3) months. There was no death during the follow-up period, and all patients experienced obvious clinical improvement. Only one child underwent subsequent aortic balloon angioplasty due to restenosis. Computed tomography angiography showed that the AA morphology was smooth, with no aortic aneurysm or angulation deformity.Conclusion:AA reconstruction with coarctation resection and aortoplasty with autologous pulmonary artery patch could effectively correct CoA with AAH, and the rate of reintervention for restenosis is low.

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Aortic Arch Reconstruction in Neonates with Biventricular Morphology: Increased Risk for Development of Recoarctation by Use of Autologous Pericardium

Abstract: Re-CoA following neonatal aortic arch surgery can be treated by balloon dilatation or surgery, if adequate. In this study, the risk for development of Re-CoA was independently increased by the use of autologous pericardium during initial arch repair.

Cited by 18 publications

References 15 publications

Off-pump ascending aorta or aortic arch to descending aorta bypass with a pericardial roll for the treatment of critically ill infants with interrupted aortic arch

Off-pump ascending aorta or aortic arch to descending aorta bypass with a pericardial roll for the treatment of critically ill infants with interrupted aortic arch

Short- and mid-term outcomes of aortic arch reconstruction: Beating heart versus cardiac arrest

Coarctation of the Aorta with Aortic Arch Hypoplasia

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