HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Emre Belli François Lacour-Gayet Claude Planché Alain Serraf Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Roussin, R. Articles by Serraf, A. Search for Related Content PubMed PubMed Citation Articles by Roussin, R. Articles by Serraf, A. Related Collections Congenital - acyanotic

J Thorac Cardiovasc Surg 2002;123:443-450
© 2002 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Aortic arch reconstruction with pulmonary autograft patch aortoplasty

From the Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis-Robinson, France,^a Department of Pediatric Cardiac Surgery, Deutsches Kinderherzzentrum, Sankt Augustin, Germany,^b and Department of Pediatric Cardiology, University Hospital, Lille, France.^c

Received for publication May 14, 2001; revisions requested June 22, 2001; revisions received July 24, 2001; accepted for publication Sept 7, 2001. Address for reprints: Alain Serraf, MD, Pediatric Cardiac Surgery, Marie Lannelongue Hospital, 133, Avenue de la Résistance, 92300, Le Plessis-Robinson, France.

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 < .0001 for group III vs group II).
Conclusions: The aortic arch repair associated with pulmonary autograft patch augmentation resulted in superior midterm outcomes and therefore constitutes a reliable alternative to the direct anastomosis technique. It allowed complete relief of anatomic afterload and diminished the anastomotic tension, thus reducing the risk of restenosis and tracheobronchial compression. We observed a significantly higher rate of recurrence after patch aortoplasty with other materials.

This article has been cited by other articles:

				W. K. Jhang, J.-J. Park, D.-M. Seo, H. W. Goo, and M. Gwak Perioperative evaluation of airways in patients with arch obstruction and intracardiac defects. Ann. Thorac. Surg., May 1, 2008; 85(5): 1753 - 1758. [Abstract] [Full Text] [PDF]

				J. W. Brown, M. Ruzmetov, Y. Okada, P. Vijay, M. D. Rodefeld, and M. W. Turrentine Outcomes in patients with interrupted aortic arch and associated anomalies: a 20-year experience. Eur. J. Cardiothorac. Surg., May 1, 2006; 29(5): 666 - 673. [Abstract] [Full Text] [PDF]

				J. L. Monro Editorial comment: Interrupted aortic arch Eur. J. Cardiothorac. Surg., May 1, 2006; 29(5): 673 - 674. [Full Text] [PDF]

				T. Miyamoto, N. Sinzobahamvya, D. Kumpikaite, B. Asfour, J. Photiadis, A. M. Brecher, and A. E. Urban Repair of Truncus Arteriosus and Aortic Arch Interruption: Outcome Analysis Ann. Thorac. Surg., June 1, 2005; 79(6): 2077 - 2082. [Abstract] [Full Text] [PDF]

				A. Kadner, H. Dave, D. Bettex, E. Valsangiacomo-Buechel, M. I. Turina, and R. Pretre Anatomic reconstruction of recurrent aortic arch obstruction in children Eur. J. Cardiothorac. Surg., July 1, 2004; 26(1): 60 - 65. [Abstract] [Full Text] [PDF]

				S. Mohammadi, A. Serraf, E. Belli, B. Aupecle, A. Capderou, F. Lacour-Gayet, I. Martinovic, D. Piot, A. Touchot, J. Losay, et al. Left-sided lesions after anatomic repair of transposition of the great arteries, ventricular septal defect, and coarctation: Surgical factors J. Thorac. Cardiovasc. Surg., July 1, 2004; 128(1): 44 - 52. [Abstract] [Full Text] [PDF]

				F. Lacour-Gayet, H. Sauer, K. Ntalakoura, A. Muller, V. Razek, J. Weil, and C. Haun Ross-Konno procedure in neonates: report of three patients Ann. Thorac. Surg., June 1, 2004; 77(6): 2223 - 2225. [Abstract] [Full Text] [PDF]

				G. Cetin, E. Tireli, A. Ozkara, and F. Oztunc The use of pulmonary autograft patch for type A aortic interruption and Swiss-cheese ventricular septal defect (VSD) Interactive CardioVascular and Thoracic Surgery, March 1, 2004; 3(1): 145 - 147. [Abstract] [Full Text] [PDF]