 |
|
| Resection of Posterior Coarctation Shelf Reduces Neoaortic Obstruction in HLHS. |
|
Back to 86th Annual Meeting Back to Program Outline Objective: Neoaortic obstruction (NAO) at the level of distal arch repair in the Norwood operation is an important factor affecting interstage mortality in HLHS. Various surgical approaches have been advocated for aortic arch reconstruction in HLHS but there is no accepted standard surgical management. We sought to determine the efficacy of different techniques for aortic arch reconstruction, to reduce the incidence of postoperative NAO. Methods: From January 2000 through June 2005, 220 pts (134 males and 86 females) with HLHS or anatomic variants underwent a Norwood operation. To enlarge the aortic arch, 6% (13 pts) of pts had a direct connection between the aorta and the pulmonary trunk (group I), 54% (118 pts) received an aortic wall homograft patch (group II), 25% (56 pts) a pulmonary wall homograft patch (group III) and 15% (32 pts) autologous pericardium treated with glutaraldehyde (group IV). One pt was missing this variable. Independent of the technique for aortic enlargement, 58/220 children had distal aortic transaction, resection of the posterior shelf of coarctation, and end-to-end anastomosis with the arch augmentation. NAO was defined as an echocardiographic mean gradient equal to or higher than 15-mm Hg or need for balloon dilation of the aortic arch in the first year of life. Results: Eighty pts (36%) developed significant arch gradient by echo, before the stage II and 39 (18%) required balloon dilation. Preoperative aortic coarctation was consistently linked to NAO (p=0.007). The incidence of echocardiographic NAO was 31% in group I, 45% in group II, 34% in group III and 20% in group IV (p=0.076). Balloon dilation was required in 0/13 pts in group I, 29/119 pts in group II, 7/55 in group III and 3/33 in group IV (p=0.032). Resection of the posterior shelf of coarctation resulted in lower incidence of NAO by echo (p=0.015) or need for balloon dilation (p=0.009). Conclusions: Patients with HLHS undergoing aortic arch enlargement with primary reconstruction or autologous treated pericardium are less likely to require intervention for NAO as compared to those having aortic homograft patch reconstruction. Excision of all ductal tissue by resection of the posterior shelf of coarctation, significantly reduces the risk of recurrent aortic arch obstruction. An aggressive approach to reconstruction of the arch and the use of autologous tissue at the time of stage I is advocated. Back to 86th Annual Meeting Back to Program Outline |
We Model Excellence |
 |
Copyright © American Association for Thoracic Surgery. All rights reserved.
Read the Privacy Policy.
IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.
Read the Privacy Policy.
IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.