1. Aortic arch reconstruction with pulmonary autograft patch aortoplasty
- Author
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Alain Serraf, Christian Rey, Claude Planché, Emre Belli, Régine Roussin, François Lacour-Gayet, François Godart, and Jacqueline Bruniaux
- Subjects
Heart Septal Defects, Ventricular ,Reoperation ,Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,medicine.medical_treatment ,Aorta, Thoracic ,Pulmonary Artery ,Anastomosis ,Transplantation, Autologous ,Aortic Coarctation ,Blood Vessel Prosthesis Implantation ,Afterload ,Recurrence ,Ductus arteriosus ,medicine.artery ,Internal medicine ,medicine ,Humans ,Cardiac Surgical Procedures ,Retrospective Studies ,Aorta ,business.industry ,Anastomosis, Surgical ,Interrupted aortic arch ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Median sternotomy ,Pulmonary artery ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
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
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