Extended end-to-end repair and enlargement of the entire arch in complex coarctation

Dolores A. Vitullo*, Serafin Y. DeLeon, Lynn C. Graham, Benjamin W. Eidem, Patrick T. Roughneen, Joseph J. Javorski, Frank Cetta

*Corresponding author for this work

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

Background. Treatment of hypoplasia of the entire arch in coarctation is a surgical challenge. The current approaches have technical difficulties, high recurrence rates, and increased morbidity and mortality. Methods. Over a 14-month period, a combined extended end-to-end repair with patch enlargement of the concavity of the entire arch was performed in 6 neonates and 1 infant. Through a midsternotomy and using cardiopulmonary bypass and hypothermia, extended end-to-end repair was performed initially leaving the proximal anastomosis open. The enlarging polytetrafluoroethylene patch was then sutured starting at the incised descending aorta distal to the extended end- to-end repair and continued retrogradely through the transverse arch to the ascending aorta proximal to the aortic cannulation site. One neonate had a patent ductus arteriosus and another had ventricular septal defect closure. One neonate had arterial switch and 3 had Norwood-type procedures performed with the enlarging patch extended to the pulmonary artery anastomosis. The remaining infant had arch enlargement performed after an arterial switch procedure and extended end-to-end repair. Results. All patients did well and showed no residual gradient up to 1 year follow-up. Two patients successfully had bidirectional Glenn shunt at 9 months of age, and one had closure of residual arterial septal defect at 8 months of age. Conclusion. The combined extended end-to-end repair and arch enlargement procedure should minimize recurrence rates because of a tension-free enlargement of the entire aortic arch and elimination of the coarctation ridge and ductile tissues. Combined with the arterial switch and Norwood-type procedures, the approach results in a large neoaorta.

Original languageEnglish (US)
Pages (from-to)528-531
Number of pages4
JournalAnnals of Thoracic Surgery
Volume67
Issue number2
DOIs
StatePublished - Feb 1 1999

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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    Vitullo, D. A., DeLeon, S. Y., Graham, L. C., Eidem, B. W., Roughneen, P. T., Javorski, J. J., & Cetta, F. (1999). Extended end-to-end repair and enlargement of the entire arch in complex coarctation. Annals of Thoracic Surgery, 67(2), 528-531. https://doi.org/10.1016/S0003-4975(98)01254-5