title: Mid-Term Outcomes of a Modification of Extended Aortic Arch Anastomosis with Pulmonary Artery Banding in Single Ventricle Neonates with Hypoplastic Transverse Arch.
abstract: OBJECTIVE
  There is less certainty regarding the best strategy for treating neonates with functional single ventricle (SV) and hypoplastic aortic arch. We have applied a modified extended aortic arch anastomosis (EAAA) and main pulmonary artery banding (PAB) as an initial palliation in neonates with transverse arch hypoplasia and assessed the mid-term outcomes.
  
  
  METHODS
  In total, 10 neonates with functional SV and extensive hypoplasia or interruption of the arch underwent a modified EAAA (extended arch anastomosis with a subclavian flap) concomitant with main PAB through a thoracotomy without cardiopulmonary bypass. Patient age and weight ranged from 4 to 14 days and 2.3 to 3.8 kg, respectively.
  
  
  RESULTS
  There were no hospital deaths although there were two late deaths. Gradients across the arch were 0 to 7 mmHg at postoperative day 1 and no arch reoperations were required. Two patients required balloon aortoplasty. Nine underwent bidirectional cavopulmonary shunt and two of them needed concomitant Damus-Kaye-Stansel (DKS) anastomosis. Six have completed Fontan.
  
  
  CONCLUSIONS
  Our modification of EAAA with main PAB for SV neonates may benefit a certain population with transverse arch hypoplasia as an option to be considered. Patients with the potential for developing outflow obstruction may be best managed with an initial DKS-type palliation.
authors.affiliation: Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Bui Quoc
authors.initials: BQ
authors.lastname: Thang
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Furugaki
authors.forename: Motoo
authors.initials: M
authors.lastname: Osaka
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Shinya
authors.initials: S
authors.lastname: Kanemoto
authors.forename: Fuminaga
authors.initials: F
authors.lastname: Suetsugu
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hiramatsu
mesh_terms: D000015:Abnormalities, Multiple; D000714:Anastomosis, Surgical; D001013:Aorta, Thoracic / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D010166:Palliative Care; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000601:surgery; D013524:Surgical Flaps; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome