Results of a novel "Taco" Technique for Correction of Aortic Coarctation and Arch Hypoplasia
Mahim Malik, Muhammad Nuri, *Lester Permut, *Jonathan Chen, *David M McMullan
Seattle Childrens's Hospital, Univeristy of Washington, Seattle, WA
Results of a Novel "Taco" Technique for Correction of Aortic Coarctation and Arch Hypoplasia
Optimal technique for repair of aortic coarctation and arch hypoplasia remain a subject of controversy due to the unique hyperbolic paraboloid shape of the lesser curvature of the aortic arch. Using standard techniques, up to 31% of patients will require reintervention for recurrent arch obstruction. The purpose of this study is to report our experience with a novel and reproducible technique for correcting diffuse aortic arch hypoplasia with coarctation.
Medical records for patients who underwent aortic arch repair between 2014 to 2016 for hemodynamically significant aortic coarctation and arch hypoplasia were retrospectively analyzed. Patients who underwent single ventricle palliation were excluded. Surgical arch repair was performed via median sternotomy, employing cardiopulmonary bypass and continuous cerebral perfusion via direct aortic cannulation. Arch reconstructions were performed with a uniform circular autologous pericardial "taco-shaped" patch.
During the study period, thirteen patients underwent Taco arch reconstruction. Median patient age was 15 days (3 days to 3 years); median weight was 2.9 kg (1.7 to 13.1 kg). Seven patients (53.8%) had associated bicuspid aortic valve and five patients (38.4%) had clinical features consistent with Shone's complex. Surgical repair of concomitant intracardiac defects was performed in 7 (53.8%) patients: (3 (23.1%) VSD closure, 1 (7.7%) complete atrioventricular septal defect repair; 1 (7.7%) subaortic membrane resection, and 1 (7.7%) aortic valvuloplasty). Median duration of cardiopulmonary bypass for isolated arch repair was 96 min (80 to 130 min); median duration of aortic cross-clamp was 40 min (32 to 60 min). Deep hypothermic circulatory arrest was utilized in 3 (23.1%) patients (12 min, 5 min and 1.3 min). All patients survived and freedom from arch reintervention was 77% during a median follow up period of 15 months (1 month to 33 months). Three (23%) patients required reintervention to address restenosis after a median interval +of 0.97 months (range 0.3 months to 3.3 months (Figure). One patient required distal aortic arch balloon dilation. Two patients required revision patch augmentation of the proximal aortic arch for re-stenosis at the site of aortic cannulation. One patient (7.1%) developed left vocal cord paresis.
Circular "Taco" patch repair of aortic coarctation with aortic arch hypoplasia is a simplified, reproducible surgical technique that is associated with a relatively low rate of restenosis when compared to currently
utilized techniques. Reintervention rates following Taco repair of arch hypoplasia maybe further improved by including the aortic cannulation site in the area of augmentation. This approach is well-suited for teaching complex aortic arch reconstruction to surgical trainees.
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