Correspondence:
Mehmet Akif Onalan M.D., Acibadem Mehmet Ali Aydinlar University Faculty
of Medicine, Atakent Hospital, Department of Cardiovascular Surgery,
34303 Halkalı, İstanbul, Turkey.
Tel: +90 212 - 404 47 31
e-mail:
mehmetakifonalan@gmail.com
Fax: +90 212-404 47 97
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.
Keywords: Congenital heart disease; hypoplastic aortic arch;
aortic arch plasty