The anatomic repair of recurrent aortic arch obstruction in children and adolescentsCentral MessagePerspective
Michaela Kreuzer, MD,
Eva Sames-Dolzer, MD,
Melanie Klapper, BSc,
Andreas Tulzer, MD,
Roland Mair, MD,
Fabian Seeber, MD,
Gregor Gierlinger, MD,
Dalibor Saric, MD,
Rudolf Mair, MD
Affiliations
Michaela Kreuzer, MD
Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria; Medical Faculty, Johannes Kepler University Linz, Linz, Austria; Address for reprints: Michaela Kreuzer, MD, Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Krankenhausstr. 9, Linz, 4020, Austria.
Eva Sames-Dolzer, MD
Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria; Medical Faculty, Johannes Kepler University Linz, Linz, Austria
Melanie Klapper, BSc
Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
Andreas Tulzer, MD
Medical Faculty, Johannes Kepler University Linz, Linz, Austria; Department of Pediatric Cardiology, Kepler University Hospital, Linz, Austria
Roland Mair, MD
Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
Fabian Seeber, MD
Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
Gregor Gierlinger, MD
Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria; Medical Faculty, Johannes Kepler University Linz, Linz, Austria
Dalibor Saric, MD
Department of Pediatric Cardiology, Klinički Bolnički Centar Zagreb, Zagreb, Croatia
Rudolf Mair, MD
Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria; Medical Faculty, Johannes Kepler University Linz, Linz, Austria
Objective: Surgery for recurrent aortic arch obstruction is highly challenging and publications are rare. The aim of this retrospective, single-center study was to evaluate mortality, complications, and reintervention rate after an anatomic repair. Methods: Between 1999 and 2022, in total 946 operations on the aortic arch were performed at the Children's Heart Center Linz. In 39 cases, the indication was a recurrent or residual aortic arch obstruction or coarctation in a patient aged 18 years or younger. This is our study cohort. The aorta was reconstructed by a direct anastomosis/autograft in 20 patients, patch in 17 patients, and interposition graft in 2 adolescents. In 32 procedures, cardiopulmonary bypass with whole body perfusion was employed, in 4, antegrade cerebral perfusion was employed, in 2, a left heart bypass was employed, and in 1 no cardiopulmonary bypass was used. Results: Median (Q1, Q3) age at operation was 253 days (100, 2198 days), weight 7.5 kg (4.5, 17.8 kg). Median cardiopulmonary bypass time was 177 minutes (115, 219 minutes), crossclamp time 73 minutes (49, 102 minutes). Three infants died during the hospital stay: 1 with Williams syndrome, 1 with hypoplastic left heart syndrome, and 1 with heterotaxia. There was no death due to an arch complication. The main complications were 1 neurologic injury after postoperative resuscitation (Williams syndrome) and 1 permanent recurrent laryngeal nerve paralysis. During the follow-up period of median 8.1 years (2.6, 12 years) 1 re-reintervention on the aortic arch was necessary. Conclusions: Sophisticated reoperations on the aortic arch could be performed safely. In children, the growth potential of all segments of the aorta could be sustainably preserved by avoiding interposition or extra-anatomic bypass grafts.
