Extended end-to-end repair and enlargement of the entire arch in complex coarctation.
BACKGROUND
Treatment of hypoplasia of the entire arch in coarctation is a surgical challenge. The current approaches have technical difficulties, high recurrence rates, and increased morbidity and mortality.


METHODS
Over a 14-month period, a combined extended end-to-end repair with patch enlargement of the concavity of the entire arch was performed in 6 neonates and 1 infant. Through a midsternotomy and using cardiopulmonary bypass and hypothermia, extended end-to-end repair was performed initially leaving the proximal anastomosis open. The enlarging polytetrafluoroethylene patch was then sutured starting at the incised descending aorta distal to the extended end-to-end repair and continued retrogradely through the transverse arch to the ascending aorta proximal to the aortic cannulation site. One neonate had a patent ductus arteriosus and another had ventricular septal defect closure. One neonate had arterial switch and 3 had Norwood-type procedures performed with the enlarging patch extended to the pulmonary artery anastomosis. The remaining infant had arch enlargement performed after an arterial switch procedure and extended end-to-end repair.


RESULTS
All patients did well and showed no residual gradient up to 1 year follow-up. Two patients successfully had bidirectional Glenn shunt at 9 months of age, and one had closure of residual arterial septal defect at 8 months of age.


CONCLUSIONS
The combined extended end-to-end repair and arch enlargement procedure should minimize recurrence rates because of a tension-free enlargement of the entire aortic arch and elimination of the coarctation ridge and ductile tissues. Combined with the arterial switch and Norwood-type procedures, the approach results in a large neoaorta.
Vitullo
D A
DA
Department of Pediatrics, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois 60153, USA.
DeLeon
S Y
SY
Graham
L C
LC
Eidem
B W
BW
Roughneen
P T
PT
Javorski
J J
JJ
Cetta
F
F
D000714:Anastomosis, Surgical; D001013:Aorta, Thoracic / Q000601:surgery; D001017:Aortic Coarctation / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011138:Polytetrafluoroethylene; D013536:Suture Techniques; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene