Surgical options for proximal and distal transverse arch hypoplasia in infants with coarctation

Abstract

Background: Although various surgical techniques have been reported for aortic arch reconstruction for proximal and distal transverse arch (PDTA) hypoplasia, no consensus has been reached on a surgical option for initial arch reconstruction. This study was undertaken to review various arch reconstruction options for PDTA hypoplasia in Chinese infants. Methods: A retrospective review of 121 infants who underwent initial arch reconstruction of the proximal and distal aortic arches between 2010 and 2020 was performed. Freedom from recoarctation was analyzed using Kaplan-Meier analysis. Univariate and multivariable Cox regression analyses were performed to determine perioperative data associated with an increased risk of recoarctation after surgery. Results: Aortic arch reconstruction was performed by end-to-side anastomosis (ESA) (n=37) or patch repair [autologous pericardial patch (APP), n=53; bovine pericardial patch (BPP), n=20; autologous pulmonary artery patch (APAP), n=11]. The relative diameter of the proximal arch was 0.51±0.07, and the relative diameter of the distal arch was 0.43±0.07. The median follow-up time was 679 (range, 388-1,362) days. Recoarctation was observed in 44 (36.4%) patients. ESA was an independent risk factor for further development of recoarctation after the initial aortic arch reconstruction [hazard ratio (HR) =2.13; P=0.020].Conclusions: Aortic arch reconstruction via ESA was an independent risk factor for late recoarctation of the proximal and distal aortic arches in patients who underwent the initial surgery in infancy.

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

“…The use of a patch can sufficiently expand the hypoplastic segment to prevent recoarctation and achieve a relatively normal geometry [18,20]. In a study comparing ESA and patch aortoplasty techniques, a lower incidence of recoarctation was reported in the patch group [21]. Li et al [21] reported that the ESA method was preferable to patch aortoplasty in patients for whom ESA was suitable (i.e., individuals in which descending aorta mobilization was not limited and aortic arch geometry was normal).…”

“…In a study comparing ESA and patch aortoplasty techniques, a lower incidence of recoarctation was reported in the patch group [21]. Li et al [21] reported that the ESA method was preferable to patch aortoplasty in patients for whom ESA was suitable (i.e., individuals in which descending aorta mobilization was not limited and aortic arch geometry was normal). The authors noted that the ESA method was associated with fewer procedures and a shorter ASCP time.…”

Computed tomography angiography assessment of the degree of simple coarctation of the aorta and its relationship with surgical outcome: A retrospective analysis

“…In recent years, significant progress has been made in studying factors influencing the short-term and long-term outcomes of patients with coarctation of the aorta. The anatomical structure of the patient's aorta, nutritional status, surgical methods, and surgical approaches influence surgical prognosis ( 9 – 11 ). This study further identified risk factors associated with prolonged ICU stay in infants with simple CoA.…”

Outcomes of surgery for coarctation of the aorta based on a new classification system

“…Afterward, an incision was made along the inferior aspect of the aortic arch, usually between the innominate artery and descending aorta, and when posterior anastomosis was completed, the remaining anterior aspect of the aortic arch was supplemented with the autologous main pulmonary artery patch harvested. 6,16,17 A surgical alternative was available for patients who had a long isthmic portion (subtype b) and a sizable transverse aortic arch regardless of the anatomical features of the aortic arch. Recently, we performed modified end-to-end anastomosis combined with subclavian artery flap aortoplasty in two patients with pre-operative airway compression, as previously described.…”

“…The optimal surgical treatment for coarctation of the aorta remains controversial, in particular, in patients with tubular hypoplasia of the aortic arch. Therefore, diverse surgical techniques, including end-to-end anastomosis, subclavian artery flap aortoplasty, extended end-to-end anastomosis, 1,2 end-to-side anastomosis, 3,4 patch 5,6 or conduit repair, and other alternative options, 7 with or without cardiopulmonary bypass, have been used. We believe that the management of coarctation of the aorta should be based on the anatomical and morphological features of the aortic arch and isthmic portion.…”