Neonatal enlargement of the aortic arch roof without cardiopulmonary bypass using ductal patency for lower body perfusion: impact on long-term growth, function and shape of the aortic arch
Pasquale LD, Burkhardt B, Beck JS, Schweiger M, Cesnjevar R, Dave H (2025)
Publication Type: Journal article
Publication year: 2025
Journal
Book Volume: 40
Article Number: ivaf042
Journal Issue: 3
Abstract
OBJECTIVES: This study evaluates the long-term outcome of neonatal aortic arch roof enlargement using ductal patency in the context of coarctation associated with aortic arch hypoplasia. METHODS: Retrospective single-centre analysis of children undergoing roof enlargement of the distal arch (left common carotid artery-left subclavian artery) without cardiopulmonary bypass (utilizing ductal patency for lower body perfusion); followed by resection and extended end-to-end anastomosis, through a left posterior thoracotomy. This study evaluates the long-term outcome with emphasis on arch growth and shape. RESULTS: Thirty consecutive patients were included (2006–24). Median age and weight were 6.0 [interquartile range: 4.0–7.8)] days and 3.1 (2.7–3.5) kg, respectively. Simple congenital heart disease with simple intracardiac shunts (n ¼ 17) and complex congenital heart disease (Complete Atrioventricular Septal Defect (AVSD), interrupted aortic arch and univentricular hearts) (n ¼ 13) constituted the cohort. Non-ischaemic clamp time for roof enlargement was 43 (36–50) min. Ischaemic clamp time for coarctation resection was 23 (21–25) min. Pulmonary artery banding was performed in 19 (63.3%) patients. Twenty-seven (90%) successfully underwent staged repair at 6.1 (4.5–8.2) months age. Follow-up was complete at a median duration of 46.9 (21.7–159.9) months. All patients survived the operation and are in good health at follow-up. Median ventilation time, ICU and hospital stay were 1 (1–2), 3 (2–5) and 23.5 (14–40) days, respectively. No patient developed any neurological complication. Three developed left subclavian artery thrombosis, one requiring surgical revision. With one unrelated late accidental death 14 years after neonatal repair, Kaplan–Meier survival was 90.9 [50.8–98.7]% at 15 years. Two patients underwent arch re-enlargement at the inner curvature to accommodate the DKS during stage 2, resulting in freedom from reoperation of 93.3[75.9–98.3]% at 10 years. All survivors enjoy subjective normal exercise tolerance with no relevant gradient. No patient is on anti-hypertensive medication. Median Z value of the proximal, transverse and distal arch was normalized to −0.88 (−2.19 to −0.12), −0.66(−1.33 to 0.08) and 0.34 (−0.10 to 1.33), respectively, at the last follow-up. Twenty-three (76.7%) arches achieved Romanesque shape at follow-up. CONCLUSIONS: Long-term results of this minimally invasive approach show proportional growth without relevant gradient, freedom from hypertension and a Roman arch form, thus making it the preferred approach.
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Switzerland (CH)How to cite
APA:
Pasquale, L.D., Burkhardt, B., Beck, J.S., Schweiger, M., Cesnjevar, R., & Dave, H. (2025). Neonatal enlargement of the aortic arch roof without cardiopulmonary bypass using ductal patency for lower body perfusion: impact on long-term growth, function and shape of the aortic arch. Interdisciplinary CardioVascular and Thoracic Surgery, 40(3). https://doi.org/10.1093/icvts/ivaf042
MLA:
Pasquale, Luigi Di, et al. "Neonatal enlargement of the aortic arch roof without cardiopulmonary bypass using ductal patency for lower body perfusion: impact on long-term growth, function and shape of the aortic arch." Interdisciplinary CardioVascular and Thoracic Surgery 40.3 (2025).
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