Aortic arch reconstruction with pulmonary autograft patch aortoplasty.
OBJECTIVE
The optimal technique for aortic arch reconstruction through median sternotomy is still under debate. We have introduced the technique of pulmonary autograft patch aortoplasty as a reliable alternative.


METHODS
The outcomes of 51 infants who underwent neonatal repair of interrupted aortic arch (n = 28) or coarctation associated with ventricular septal defect (n = 23) since 1992 were analyzed. The patients were reviewed in three groups according to the aortic arch reconstruction technique: group I underwent direct anastomosis (n = 23), group II underwent homograft or pericardial patch aortoplasty (n = 8), and group III underwent pulmonary autograft patch aortoplasty (n = 20). The pulmonary autograft patch consisted in the anterior wall of the main pulmonary artery, between the supracommissural level and the divided ductus arteriosus. The created defect was replaced with fresh autologous pericardium.


RESULTS
All patients except 1 were discharged without significant residual gradient at the level of the aortic arch. At a median delay of 7 months (range 2-51 months), 11 patients (22%) had recurrence of arch obstruction and underwent balloon angioplasty (n = 8) or surgical correction (n = 3). One patient who had undergone direct anastomosis required reoperation for bronchial compression. At a median follow-up of 29 months, the actuarial freedoms from recurrent arch obstruction were 81% for direct anastomosis, 28% for homograft or pericardial patch aortoplasty, and 100% for pulmonary autograft aortoplasty (P =.03 for group III vs group I and P <.0001 for group III vs group II).


CONCLUSIONS
The aortic arch repair associated with pulmonary autograft patch augmentation resulted in superior midterm outcomes and therefore constitutes a reliable alternative to the direct anastomosis technique. It allowed complete relief of anatomic afterload and diminished the anastomotic tension, thus reducing the risk of restenosis and tracheobronchial compression. We observed a significantly higher rate of recurrence after patch aortoplasty with other materials.
Roussin
Régine
R
Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, 133 Avenue de la Résistance, 92300 Le Plessis-Robinson, France.
Belli
Emre
E
Lacour-Gayet
François
F
Godart
Francois
F
Rey
Christian
C
Bruniaux
Jacqueline
J
Planché
Claude
C
Serraf
Alain
A
D000714:Anastomosis, Surgical; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000601:surgery*; D001017:Aortic Coarctation / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D006348:Cardiac Surgical Procedures; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006801:Humans; D011651:Pulmonary Artery / Q000637:transplantation*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome