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Patukale A, Shikata F, Marathe SS, Patel P, Marathe SP, Colen T, Venugopal P, Suna J, Betts K, Karl TR, Johnson J, Versluis K, Alphonso N. A single-centre, retrospective study of mid-term outcomes of aortic arch repair using a standardized resection and patch augmentation technique. Interact Cardiovasc Thorac Surg 2022; 35:6594494. [PMID: 35640134 PMCID: PMC9419687 DOI: 10.1093/icvts/ivac135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/19/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to evaluate the mid-term outcomes after the 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 (IAA) in a single institute from June 2012 to December 2019 by a standardized patch augmentation (irrespective of concomitant intra-cardiac lesions). End points evaluated were reintervention for arch obstruction and persistent/new-onset hypertension.
RESULTS
The study included 149 patients [hypoplastic aortic arch, n = 92 (62%), IAA, 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%). The median age and weight at surgery were 7 days [interquartile range (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% confidence interval (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.
CONCLUSIONS
Repair of hypoplastic/IAA by transection and excision of all ductal tissue and standardized patch augmentation provide 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.
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Affiliation(s)
- Aditya Patukale
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital , Brisbane, QLD, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland , Brisbane, QLD, Australia
| | | | - Shilpa S Marathe
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital , Brisbane, QLD, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland , Brisbane, QLD, Australia
| | - Pervez Patel
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital , Brisbane, QLD, Australia
| | - Supreet P Marathe
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital , Brisbane, QLD, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland , Brisbane, QLD, Australia
- Children’s Health Research Centre, University of Queensland , Brisbane, QLD, Australia
| | - Timothy Colen
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital , Brisbane, QLD, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland , Brisbane, QLD, Australia
| | - Prem Venugopal
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital , Brisbane, QLD, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland , Brisbane, QLD, Australia
- Children’s Health Research Centre, University of Queensland , Brisbane, QLD, Australia
| | | | | | | | | | | | - Nelson Alphonso
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children’s Hospital , Brisbane, QLD, Australia
- School of Clinical Medicine, Children’s Health Queensland Clinical Unit, University of Queensland , Brisbane, QLD, Australia
- Children’s Health Research Centre, University of Queensland , Brisbane, QLD, Australia
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