Materials and methods
Medical records of 60 consecutive patients who underwent aortic arch
reconstruction between January 2014 and December 2019 were
retrospectively reviewed. Patients with hypoplastic left heart syndrome,
interrupted aortic arch, and isolated coarctation were excluded from the
study. All patients but 3 had associated intracardiac anomaly. Our study
received ATADEK-2020/2 (numbered 2020-2/6) Ethics Committee approval on
11/02/2020. We defined aortic arch hypoplasia according to the above
mentioned criteria1. Transthoracic echocardiography
was used for the diagnosis of all patients. Their aortic arch anatomy
were examined in detail. Computerized tomography angiography was
performed upon any suspicion on the echocardiographic diagnosis. The
mean diameter of proximal transvers arch (between the innominate and the
left carotid arteries) was 3.61± 0.9 mm (the mean Z score: -5.21±
-1.44), distal transvers arch (between the left carotid and the left
subclavian arteries) was 3.6 ± 0.91 mm (the mean Z score: -3.24 ±
-1.38), and the isthmic arch (between the left subclavian and the ductus
arteriosus) was 2.98± 0.93 mm (the mean Z score: -3.98 ± -1.65).
The age of the patients ranged from 4 to 120 days (median 19.5 days),
their weight ranged from 2 to 5.3 kg (mean, 3.2 ± 0.73 kg), and their
body surface area (BSA) ranged from 0.16 to 0.28 m2(mean, 0.21± 0.02 m2). Fourty-six patients (76.6%)
were neonates, and 11 patients were prematures (18.3%). Male to female
ratio was 35/25 (58.4% / 41.6%).
The patients were divided into two groups: Group 1 consisted of 23
patients who underwent palliation with pulmonary artery banding
concomitant to aortic arch repair. Group 2 consisted of 37 patients who
underwent single-stage total repair. The main characteristics,
associated intracardiac anomalies, operative details, and perfusion
strategies for both groups are described in table 1 and 2 .
Ductal dependency and prostaglandin E1 infusion were necessary in 45
patients (75%), and forty-two patients (70%) had congestive heart
failure preoperatively. Sixteen patients (26.6%) were required
mechanical ventilatory support before the operation. Three patients had
trisomy 21, and 3 had Williams syndrome. Twelve patients (20%) had poor
preoperative clinical conditions. Five of them were treated for sepsis,
4 had congenital pneumonia, 2 had acute renal failure, and the last one
had multiorgan failure. Three patients had undergone surgery due to
esophageal atresia (n = 2) and anal atresia (n = 1) before cardiac
operations.