Single center experience of aortic bypass graft for aortic arch obstruction in children

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease
• Vascular Reconstruction

Background:

• Aortic arch obstruction is a serious congenital heart defect requiring surgical intervention.
• Aortic bypass graft placement is a critical procedure for managing aortic arch obstruction in pediatric patients.
• Outcomes and long-term results of this procedure in children are crucial for clinical decision-making.

Purpose of the Study:

• To evaluate the outcomes of aortic bypass graft placement in pediatric patients with aortic arch obstruction.
• To compare survival and reoperation rates based on patient age and graft size.

Main Methods:

• Retrospective review of 70 pediatric patients undergoing primary aortic bypass graft placement for aortic arch obstruction (1982-2013).
• Actuarial survival and freedom from aortic arch reoperation were calculated.
• Comparison of outcomes between children younger than 1 year and older than 1 year, and by graft size (>16 mm vs. <16 mm).

Main Results:

• Overall actuarial transplant-free survival was 64.7% at 20 years; freedom from reoperation was 50.5% at 10 years.
• Children older than 1 year had significantly better transplant-free survival (100% at 15 years) and freedom from reoperation (100% at 10 years) compared to those younger than 1 year (56.4% and 18.7%, respectively).
• Patients receiving aortic bypass grafts larger than 16 mm experienced no aortic arch reoperations at 15 years.

Conclusions:

• Aortic bypass graft placement for aortic arch obstruction can be performed with low mortality and morbidity, particularly when using grafts larger than 16 mm.
• The procedure is associated with significantly poorer outcomes in neonates and infants compared to older children.
• Careful patient selection is essential, with avoidance in neonates and infants recommended except in specific circumstances.