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.