Mid-Term Outcomes of a Modification of Extended Aortic Arch Anastomosis with Pulmonary Artery Banding in Single Ventricle Neonates with Hypoplastic Transverse Arch

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Author(s)

    • Thang Bui Quoc
    • Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
    • Furugaki Tatsuya
    • Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
    • Osaka Motoo
    • Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
    • Watanabe Yutaka
    • Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
    • Kanemoto Shinya
    • Department of Cardiovascular Surgery, Kansai Medical University, Hirakata, Osaka, Japan
    • Suetsugu Fuminaga
    • Department of Cardiovascular Surgery, Suetsugu Clinic, Kitakyushu, Fukuoka, Japan
    • Hiramatsu Yuji
    • Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan

Abstract

<p>Purpose: There is less certainty regarding the best strategy for treating neonates with functional single ventricle (SV) and hypoplastic aortic arch. We have applied a modified extended aortic arch anastomosis (EAAA) and main pulmonary artery banding (PAB) as an initial palliation in neonates with transverse arch hypoplasia and assessed the mid-term outcomes.</p><p>Methods: In total, 10 neonates with functional SV and extensive hypoplasia or interruption of the arch underwent a modified EAAA (extended arch anastomosis with a subclavian flap) concomitant with main PAB through a thoracotomy without cardiopulmonary bypass. Patient age and weight ranged from 4 to 14 days and 2.3 to 3.8 kg, respectively.</p><p>Results: There were no hospital deaths although there were two late deaths. Gradients across the arch were 0 to 7 mmHg at postoperative day 1 and no arch reoperations were required. Two patients required balloon aortoplasty. Nine underwent bidirectional cavopulmonary shunt and two of them needed concomitant Damus–Kaye–Stansel (DKS) anastomosis. Six have completed Fontan.</p><p>Conclusion: Our modification of EAAA with main PAB for SV neonates may benefit a certain population with transverse arch hypoplasia as an option to be considered. Patients with the potential for developing outflow obstruction may be best managed with an initial DKS-type palliation.</p>

Journal

  • Annals of Thoracic and Cardiovascular Surgery

    Annals of Thoracic and Cardiovascular Surgery 22(6), 340-347, 2016

    The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery

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