A Single Centre, Retrospective Study of Mid-term Outcomes of Aortic Arch Repair Using a Standardized Resection and Patch Augmentation Technique

Abstract

OBJECTIVES: To evaluate the mid-term outcomes after repair of aortic arch using a standard patch augmentation technique. METHODS: The study included all patients who underwent repair of a hypoplastic/interrupted aortic arch in a single institute from June 2012 to December 2019 by a standardized patch augmentation (irrespective of concomitant intra-cardiac lesions). Endpoints evaluated were reintervention for arch obstruction and persistent/new onset hypertension. RESULTS: The study included 149 patients [hypoplastic aortic arch, n = 92 (62%), interrupted aortic arch, n = 9 (6%), Norwood procedure, n = 48 (32%)]. The patch material used for augmentation of the aortic arch included pulmonary homograft (n = 120, 81%), homograft pericardium (n = 18, 12%), CardioCel® (n = 9, 6%) and glutaraldehyde treated autologous pericardium (n = 2, 1%).Median age and weight at surgery was 7 days (IQR 5-17 days) and 3.5 kg (IQR 3-3.9 kg) respectively. The median follow-up was 3.27 years (IQR 1.28, 5.08), range (0.02, 8.76).Freedom from reintervention at 1, 3 and 5 years was 95% (95% CI = 89%, 98%), 93% (95% CI = 86%, 96%), and 93% (95% CI = 86%, 96%) respectively. One patient (0.6%) had persistent hypertension 8 years after correction for interrupted arch with truncus arteriosus. CONCLUSION: Repair of hypoplastic/interrupted aortic arch by transection and excision of all ductal tissue and standardised patch augmentation provides good mid-term durability. The freedom from reintervention at 5 years is > 90%. The incidence of persistent systemic hypertension following arch reconstruction is low. The technique is reproducible and applicable irrespective of underlying arch anatomy.L6381389662022-06-08 <br />