Long‐term results of aortic arch reconstruction with branch pulmonary artery homograft patches

Abstract

Background Homograft tissue is an important reconstructive material used in the surgical correction of a variety of congenital heart defects. The aim of this study is to evaluate the long‐term outcome of pulmonary artery (PA) branch patches used in the reconstruction of the thoracic aorta in children. Methods Retrospective review of 124 consecutive pediatric patients undergoing corrective surgery for their congenital heart defects between 2001 and 2016. Survival, reoperation, and reintervention data were collected, as well as imaging data to assess for presence of recoarctation, dilation, or aneurysm formation in the area of patch reconstruction. Results Overall 15‐year survival was 83.9% and 15‐year freedom from reintervention in the area of patch reconstruction was 89.2%. Rates of mortality (0%), cardiac transplantation (0%), and reoperation (0.8%) attributable to the area of patch reconstruction were low. The frequency of catheter‐based intervention in the area of patch reconstruction was 9.7%; such interventions were successful in all but one patient, who ultimately underwent successful surgical aortoplasty. Conclusions Homograft patches harvested from PA branches are an effective reconstructive material used for reconstruction of the aorta in small children. Long‐term results show no risk of aneurysm formation and low rates of stenosis formation.

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

“…1 The advancement in clinical practice and the use of moderate to deep hypothermic circulatory arrest combined with adjunct brain protection in the form of selective cerebral perfusion have had significant impact on improved outcomes over the period of time. 4,5 There is wide variation in practice and reported outcomes, especially early and late mortality. 4,5,6,7 Rakhra et al reported their outcomes on 305 patients that had AAH and coarctation repair with an early mortality rate of 9% and re-intervention rate was needed on eight patients prior to discharge from the hospital due to residual obstruction while late re-interventions of 66 accounts were reported in 49 (18%) patients.…”

“…3 Nowadays, AAH reconstruction using pulmonary homograft patch with coarctation excision is the preferred technique for repair. 4,5 This procedure is performed on cardiopulmonary bypass (CPB) under deep hypothermic circulatory arrest with retrograde cerebral perfusion (RCP). 4,5 Recurrent aortic arch obstruction and neurological adverse events are common complications following AAH reconstruction.…”

“…4,5 This procedure is performed on cardiopulmonary bypass (CPB) under deep hypothermic circulatory arrest with retrograde cerebral perfusion (RCP). 4,5 Recurrent aortic arch obstruction and neurological adverse events are common complications following AAH reconstruction. 1,2,6 The aim of our study is to report our experience on AAH reconstruction in our institute addressing our results and the main complications after this complex procedure.…”

Vascular allografts for clinical application in Europe: assessment of 30 years of experience with vascular tissue banking in Brussels

“…The authors considered the allograft patches harvested from PA branches to be an effective material for reconstruction of the aorta in small children. Long-term results showed no risk of aneurysm formation and low rates of stenosis formation (Lewis 2020 ).…”

“…For the reconstruction of the aortic arch in newborn patients and children, our institution distributed 643 allografts or approximately 15% of all distributed CVAs (during the second and third periods) and approximately 10% during the first period. Many paediatric cardiac surgeons consider the cryopreserved allogenic nonvalvular pulmonary conduit (nVPC) as a “gold standard” for the repair of hypoplastic left heart syndrome (HLHS) or arch interruption (Amri 2022 ; Lewis 2020 ; van Beynum 2021 ). Our TE distributed 46, 220 and 377 nVPCs during the first, second and third periods, respectively, presenting an increase of 478% in the second and 171% in the third period compared to the previous period.…”