Selective Lesser Curvature Augmentation With Geometric Study for Repair of Aortic Arch Obstruction
| Autor: | Shunsuke Matsushima, Yuson Wada, Shota Hasegawa, Yoshihiro Oshima, Tomonori Higuma, Hironori Matsuhisa |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Aortic arch medicine.medical_specialty medicine.medical_treatment Aortic Diseases Aorta Thoracic 030204 cardiovascular system & hematology Anastomosis Aortic Coarctation 03 medical and health sciences 0302 clinical medicine medicine.artery medicine Humans Arch Retrospective Studies Body surface area business.industry Interrupted aortic arch Infant Newborn medicine.disease Curvatures of the stomach Surgery 030228 respiratory system Median sternotomy Female Bronchomalacia Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures |
| Zdroj: | The Annals of Thoracic Surgery. 112:1523-1531 |
| ISSN: | 0003-4975 |
| Popis: | Background We repaired aortic coarctation and interrupted aortic arch with extended end-to-end anastomosis (EAA) through median sternotomy and performed lesser curvature augmentation with a pulmonary autograft patch (PAP) in selected patients with a long gap between anastomotic sites. We reviewed these outcomes and geometric implications. Methods All neonates and infants with biventricular morphology who underwent aortic arch reconstruction through median sternotomy between 2005 and 2019 were evaluated. Aortic arch geometry was analyzed with computed tomography routinely performed before and after surgery from 2009 on. Results There were 91 consecutive patients (median age, 1.2 months). Ten patients received PAP. One early death and no late deaths were noted. Overall survival was 98.9% at 10 years. Two left bronchomalacia and 1 recoarctation occurred in patients with EAA. Freedom from recoarctation was 97.4% at 10 years. We examined 68 patients with computed tomography. We used PAP in patients with a significantly longer gap between anastomotic sites indexed by the square root of the body surface area; its cutoff value was 29.0 mm/m (area under the curve, 0.86 mm/m). The PAP created a significantly greater arch angle (median, 91° versus 83°) and arch/descending diameter ratio (median, 1.2 versus 1.0) and preserved the arch width indexed by the square root of the body surface area (median, before surgery: 35.7 versus 34.4 mm/m; after surgery: 36.5 versus 29.9mm/m), compared with EAA. Conclusions Aortic arch reconstruction with the current combined strategy provides satisfactory outcomes. Guided by geometric analysis, lesser curvature augmentation can be applied to patients who might experience recoarctation or airway compression with a directly anastomosed aortic arch. |
| Databáze: | OpenAIRE |
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