title: Aortic arch reconstruction in newborns with an autologous pericardial patch: contemporary results.
abstract: OBJECTIVE
  The incidence of recurrent aortic arch obstruction after Norwood procedure and other types of aortic arch reconstruction in newborns remains high. Biological and synthetic materials are used to enlarge the aorta. We report our experience using autologous pericardium to reconstruct the aortic arch in patients with hypoplastic left heart syndrome, aortic arch interruption and hypoplastic aortic arch.
  
  
  METHODS
  A retrospective analysis of 39 consecutively operated patients evaluated after an initial Norwood and other types aortic arch repair was performed. The presence of recurrent arch obstruction (mean gradient ≥ 20 mmHg) and its management were noted. The mean weight of our patients was 3.2 ± 0.7 kg.
  
  
  RESULTS
  The mean age at primary surgical correction was 7.4 ± 6.8 (range 1-35 days). All patients were discharged without a significant residual gradient at the aortic arch except 4 who had a peak gradient of ≥ 30 mmHg. The overall incidence of recurrent arch obstruction was 28.2% (11 patients). Four (12.1%) patients had a distal obstruction, 1 (3%) had proximal obstruction and 1 had a mid-transverse arch obstruction. All patients underwent aortic arch reintervention consisting of balloon dilatation, and only after unsuccessful dilatation, 3 underwent surgical patch aortoplasties.
  
  
  CONCLUSIONS
  The use of autologous pericardium in aortic arch reconstruction procedure is effective and associated with an acceptable incidence of recurrent arch obstruction. Its availability and characteristics make it an attractive alternative to other materials.
authors.affiliation: Department of Congenital Heart Disease,  Ospedale Del Cuore Fondazione G. Monasterio, Massa,  Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bernabei
authors.forename: Rafik
authors.initials: R
authors.lastname: Margaryan
authors.forename: Luigi
authors.initials: L
authors.lastname: Arcieri
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bianchi
authors.forename: Vitali
authors.initials: V
authors.lastname: Pak
authors.forename: Bruno
authors.initials: B
authors.lastname: Murzi
mesh_terms: D001013:Aorta, Thoracic / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D062186:Arterial Pressure; D016009:Chi-Square Distribution; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D058327:Norwood Procedures / Q000009:adverse effects / Q000401:mortality; D010496:Pericardium / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome