Original articlePediatric cardiacAscending Sliding Arch Aortoplasty: A Novel Technique for Repair of Arch Hypoplasia
Section snippets
Patient Population
After Institutional Review Board approval and a waiver of consent, a retrospective review of medical records and the department clinical database identified 8 children, median age of 8.5 years (range 1.5 to 15.7), who had undergone surgical repair of arch obstruction utilizing ASAA. Interestingly, all 8 patients were male, which is consistent with the striking male-to-female ratio of nearly 70% seen with CoA [6]. Three patients had persistent obstruction at the level of the arch after various
Operative Data and Morbidity
Mean CPB time was 157 ± 19 minutes, and mean aortic cross-clamp time was 77 ± 29 minutes. Mean SCP time was 42 ± 10 minutes, and a brief period of circulatory arrest was necessary in 2 patients, 3 and 5 minutes, respectively, to finalize the anastomosis and to remove air from the aortic lumen. The lowest recorded mean cerebral oxygen saturation during SCP as determined by near-infrared spectroscopy was 92% ± 3%. Median hospital length of stay was 5.5 days (range 3 to 10). There has been no
Comment
Coarctation of the aorta is frequently associated with hypoplasia of the aortic arch. The clinical relevance of various degrees of arch hypoplasia in growing children is controversial and is confounded further by the difficulty in accurately assessing arch obstruction in the presence of juxtaductal CoA. The hypoplastic arch is frequently elongated, adding to the resistance to blood flow; however, elongation is difficult to quantify, and normal standards beyond the neonatal period are not well
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Cited by (17)
Current Readings on Surgery for the Neonate With Hypoplastic Aortic Arch
2017, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :An interesting strategy that has been described by the group in Houston is the ascending sliding arch aortoplasty in which coarctectomy is performed and a three-quarter circumference end-to-end anastomosis is first accomplished between the proximal descending aorta and the distal arch. The distal ascending aorta is then transected at the level of the proximal arch and incised longitudinally on its right anterolateral aspect, creating a tongue or a flap that is advanced and will be used to complete the reconstruction of the inner curvature of the arch.28 The advantages of this strategy in patients with recurrent arch obstruction include its efficiency in reconstructing the arch despite decreased mobility compared with the initial operation, and the avoidance of the use of a patch material and its related degeneration or calcification.
Aortic Arch Advancement and Ascending Sliding Arch Aortoplasty for Repair of Complex Primary and Recurrent Aortic Arch Obstruction
2017, Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery AnnualCitation Excerpt :After restoration of full flow, reperfusion of the heart, rewarming, and separation from CPB is accomplished. Our experience with both the AAA and ascending sliding arch aortoplasty have been previously published.4,5 Our experience with the AAA spanned 17 years and included 275 patients with a perioperative mortality of 3% (eight patients) and in most of those patients the mortality could not be attributed just to the procedure but other pre-existing factors, such as syndromes, complex single ventricle repair, preoperative shock, prematurity, and complex biventricular repair.
Anatomic Repair of Recurrent Aortic Arch Obstruction
2012, Operative Techniques in Thoracic and Cardiovascular SurgeryCitation Excerpt :No patients had required subsequent aortic interventions at 85 months postoperatively and only 2 patients had a 10 mm Hg arm-to-leg pressure gradient. The technique of ascending sliding arch aortoplasty was recently described by our group.2 This report included 8 patients aged 18 months to 15 years, of which 3 had prior procedures for aortic coarctation.
Clinical Assessment of Perfusion Techniques During Surgical Repair of Coarctation of Aorta With Aortic Arch Hypoplasia in Neonates: A Pilot Prospective Randomized Study
2020, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :A cold Custodiol cardioplegic solution (Dr Kohler Pharma, Alsbach-Hahnlein, Germany) was administered antegrade for myocardial protection. We routinely used one of the following aortic arch reconstruction techniques: end-to-side anastomosis, extended end-to-end anastomosis either with or without arch plasty with foreign patch material (homograft patch or glutaraldehyde-treated autologous pericardium), and ascending aortic “sliding” procedure (both the descending and ascending aortas are anastomosed with the aortic arch9). After initiation of CPB, the ductus arteriosus was ligated and transected as the body temperature of the patient was cooled to 18–20°C.
Long-Term Outcomes of Ascending Sliding Arch Aortoplasty
2024, World Journal for Pediatric and Congenital Heart Surgery