Abstract
Objectives:Surgical management of aortic arch hypoplasia with associated
intra-cardiac anomalies is a challenge in newborns.We reviewed the
characteristics and outcomes of neonates and infants who underwent
pulmonary artery banding concomitant to arch repair and single-stage
total repair at our institution. Methods:Medical records of 60 patients
undergoing aortic arch reconstruction for aortic arch hypoplasia between
2014 to 2019 were retrospectively reviewed.Twenty-five patients were
female (41.6%), and the age of the patients ranged from 4 to 120 days
(median 19.5 days).The patients were divided into two groups;Group 1 (23
patients) underwent pulmonary artery banding concomitant to arch repair,
Group 2 (37 patients) underwent single-stage total repair in addition to
arch repair.All arch repair procedures consisted of an extended (to the
midportion of the ascending aorta)patch aortoplasty.
Results:Postoperative early mortality occurred in 12 patients, 8 in
Group 1(34.8%), and 4 in Group 2 (10.8%).There was an early survival
advantage in group 2 (p=0.019).Recoarctation was occurred in 13 cases
(21.6%), and 11 (18.3%) of them required reintervention (balloon
angioplasty:7, re-operation:4).On univariate analysis, risk factors
associated with death were pulmonary artery banding
(HR,0.44;CI,0.09-2;p=0.019),prematurity
(HR,4,67;CI,1.34-16.18;p=<0.001),preoperative mechanical
ventilation support requirement (HR,0.048;CI, 0.52-6.39;p=0.048),and
functional single ventricle (HR,0.43;CI,0.1-1.86;p=0.006).The mean
duration of follow-up was 21.9±15.1 months, and there was no late death
in each group. Conclusion:Single-stage repair of aortic arch hypoplasia
with intracardiac pathologies has better results than palliation,
according to survival rates and postoperative results.The use of patch
augmentation technique in aortic arch hypoplasia is valid and associated
with an acceptable incidence of recurrent arch obstruction.