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Aortic arch advancement for aortic coarctation and hypoplastic aortic arch in neonates and infants
Carlos M Mery1, Francisco A Guzmán-Pruneda1, Kathleen E Carberry2
1Division of Congenital Heart Surgery, Texas Children's Hospital, and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Insights
Aortic arch advancement (AAA) is a safe and effective surgery for infants with hypoplastic aortic arch, showing low adverse events and reintervention rates. This technique offers native tissue reconstruction and promotes growth, making it ideal for managing this condition.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Aortic Arch Reconstruction
Background:
- Optimal treatment for infants with aortic coarctation and hypoplastic aortic arch remains debated.
- Aortic arch advancement (AAA) is a surgical technique used in managing these complex conditions.
Purpose of the Study:
- To report short-term and mid-term outcomes of aortic arch advancement (AAA) in infants with hypoplastic aortic arch.
- To evaluate the safety, efficacy, and durability of AAA.
Main Methods:
- Retrospective review of 275 infants undergoing AAA from 1995 to 2012.
- AAA involved coarctectomy and end-to-side anastomosis of the descending aorta to the proximal arch.
- Patients were categorized into four groups based on associated cardiac procedures.
Main Results:
- Median age at repair was 14 days; 17% had genetic abnormalities.
- Low rates of adverse events: 1% neurologic, 0.7% bronchial compression, 38% vocal cord dysfunction (1% residual).
- Perioperative mortality was 3%; 3% required reintervention within 6 years.
Conclusions:
- Aortic arch advancement is a safe, effective, and durable surgical option for neonates and infants with hypoplastic aortic arch.
- The procedure demonstrates low rates of adverse events and mid-term reinterventions.
- AAA facilitates native tissue reconstruction and preserves growth potential, positioning it as an ideal management technique.
Background:
The optimal treatment for infants with aortic coarctation and hypoplastic aortic arch is controversial. The goal of this study was to report the short-term and mid-term outcomes of aortic arch advancement (AAA) in infants with hypoplastic aortic arch.
Methods:
All infants who underwent AAA at our institution from 1995 to 2012 were included. AAA consisted of coarctectomy and end-to-side anastomosis of the descending aorta to the distal ascending aorta/proximal arch through a median sternotomy. The cohort was divided into four groups: (1) isolated AAA (n=29, 11%), (2) AAA with closure of ventricular septal defect (n=56, 20%), (3) AAA with other biventricular repairs (n=115, 42%), and (4) AAA as part of single-ventricle palliation (n=75, 27%).
Results:
The cohort included 275 patients: 125 (45%) were female, and the median age was 14 days (interquartile range, 7-34 days). Genetic abnormalities were present in 48 patients (17%). Neurologic adverse events occurred in 3 patients (1%), all in group 4. Left bronchial compression was seen in 2 patients (0.7%); only one required intervention. Vocal cord dysfunction was noted in 36 of 95 patients (38%) on routine laryngoscopy. Only 1 patient had clinical residual dysfunction at the last follow-up visit. Perioperative mortality was 3% (n=8). At a median follow-up time of 6 years, 8 patients (3%) had reinterventions at a median time of 5 months (3-17 months) after repair.
Conclusions:
AAA is a safe, effective, and durable operation with low rates of adverse events and mid-term reintervention. The advantages include native tissue-to-tissue reconstruction and preserved potential for growth. As such, it is the ideal technique for the management of hypoplastic aortic arch in neonates and infants.
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