title: Aortic Arch Reconstruction in Neonates with Biventricular Morphology: Increased Risk for Development of Recoarctation by Use of Autologous Pericardium.
abstract: BACKGROUND
  The aim of this study was to analyze risk factors promoting development of recoarctation (Re-CoA) in neonates who survived aortic arch repair from an anterior approach.
  
  
  METHODS
  Fifty consecutive neonates with biventricular morphology and ductal-dependent lower body perfusion who were discharged home following aortic arch repair with cardiopulmonary bypass between 2000 and 2012 were retrospectively reviewed. Arch anatomy was either interruption (n = 10) or hypoplasia with coarctation (n = 40). Aortic arch reconstruction was performed by using patch material (bovine pericardium, n = 30, homograft, n = 10, or glutaraldehyde-treated autologous pericardium, n = 7), and three patients underwent direct end-to-side anastomosis. Antegrade cerebral and continuous myocardial perfusion was performed in 39 and 21 patients, respectively. Kaplan-Meier freedom from Re-CoA was calculated. Morphologic and perioperative data indicating increased risk of Re-CoA by univariate analysis were included in multivariate Cox regression analysis.
  
  
  RESULTS
  Mean follow-up was 5.3 ± 4.1 years. Re-CoA occurred in 13 patients and was treated successfully by balloon dilatation (n = 6) or surgery (n = 7). Freedom from Re-CoA after 1 and 5 years was 83 ± 5 and 79 ± 6%, respectively. Two patients died early after surgical repair of Re-CoA. The use of autologous pericardium for aortic arch augmentation was the only independent risk factor for development of Re-CoA (hazard ratio: 4.3 [95% confidence interval: 1.2-16.1]; p = 0.028).
  
  
  CONCLUSIONS
  Re-CoA following neonatal aortic arch surgery can be treated by balloon dilatation or surgery, if adequate. In this study, the risk for development of Re-CoA was independently increased by the use of autologous pericardium during initial arch repair.
authors.affiliation: Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bechtold
authors.affiliation: Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany.
authors.forename: Ariawan
authors.initials: A
authors.lastname: Purbojo
authors.affiliation: Institute of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) Universtiätsstrasse, Erlangen, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Schwitulla
authors.affiliation: Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Glöckler
authors.affiliation: Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany.
authors.forename: Okan
authors.initials: O
authors.lastname: Toka
authors.affiliation: Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Dittrich
authors.affiliation: Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany.
authors.forename: Robert Anton
authors.initials: RA
authors.lastname: Cesnjevar
authors.affiliation: Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Rüffer
mesh_terms: D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods*; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006084:Graft Rejection; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D010496:Pericardium / Q000637:transplantation*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014182:Transplantation, Autologous / Q000009:adverse effects; D016896:Treatment Outcome