Aortic Arch Reconstruction in Congenital Heart Disease - Single Center Experience of Ten Years with Long-Term Results

Objectives: The outcome of surgical aortic arch reconstruction in congenital heart disease depends on several factors such as the primary diagnosis, surgical technique, utilized patch material for reconstruction and quality of patient follow-up. Our aim is to analyze the surgical results and the long term outcome of patients with congenital heart disease after aortic arch reconstruction between 2004 and 2013 with the use of a curved porcine pericardial patch in a single center.

Methods: The diagnoses were along with long-segment congential hypoplasia or interruption of the aorta hypoplastic left heart syndrome/complex (59.8%), D/L-transposition of the great arteries (9.8%), double outlet right ventricle (7.6%), unbalanced atrioventricular septal defect (3,3%), Shone´s complex (3.3%), others (16.2%) in 92 patients. Aortic arch reconstruction was performed at a median age of 134 days (2–8805) using selective cerebral perfusion at 26–28°C and selective myocardial perfusion in 19 patients (20.7%). Median weight of the patients was 5.3 kg (2–58). Eighteen patients (19.6%) have already had an aortic intervention before. The mortality, the morbidity, the recurrence of aortic arch obstruction as well as re-interventions were analyzed.

Results: In-hospital mortality occurred in 8.7%. Median follow-up time of survivors was 27.6 months (0.3–110.1). Aortic arch reconstruction was performed in 74 patients (80.4%) following initial hybrid stage I approach for hypoplastic left heart variants. Overall mortality was 13% (12 patients). A recurrent obstruction occurred in 23 patients (25%) and these patients underwent re-intervention after a median time of 181 days (44–2083) in 52.2% at the distal aortic arch. Percutaneous interventions were performed in 23 patients (52.2% balloon dilatation, 13% stent implantation, 34.8% both) and only 5 patients (5.4%) needed re-surgery.

Conclusions: Our long-term results revealed a low mortality and morbidity in a challenging group of patients with the use of curved porcine pericardial patch for the aortic reconstruction. The use of this material is extremely helpful particularly in the surgical palliation of hypoplastic left heart syndrome and its variants.