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Aortic growth after arch reconstruction with patch augmentation: a 2-decade experience.

Dominic P Recco1,2, Shannen B Kizilski1,2, Reena M Ghosh2,3

  • 1Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA.

Interdisciplinary Cardiovascular and Thoracic Surgery
|December 22, 2023
PubMed
Summary

Optimal aortic arch reconstruction sizing is key for long-term growth. Initial reconstruction between z-scores 0 and +1 ensures normal mid-term aortic dimensions and reduces reintervention risk, especially for the aortic isthmus.

Keywords:
Aortic archArch reconstructionCardiovascular surgeryCongenital heart diseasePatch augmentation

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Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Surgery
  • Vascular Biology

Background:

  • Aortic arch reconstruction is critical for congenital heart defects.
  • Optimal initial sizing for aortic arch reconstruction is not well-defined.
  • Under- or oversizing can lead to adverse outcomes.

Purpose of the Study:

  • To analyze longitudinal aortic growth after patch-augmented arch reconstruction.
  • To determine the ideal initial reconstructed aortic size for normal mid-term dimensions.
  • To identify factors influencing aortic growth and reintervention risk.

Main Methods:

  • Retrospective review of 54 infants undergoing Damus-Kaye-Stansel (DKS) or non-DKS arch reconstruction (2000-2021).
  • Measurement of aortic dimensions (ascending aorta, transverse arch, aortic isthmus, descending aorta) via echocardiography and cross-sectional imaging.
  • Analysis of longitudinal changes in aortic dimensions and z-scores, with secondary outcomes including reintervention rates.

Main Results:

  • All aortic segments grew significantly, with stable z-scores except for the non-DKS proximal and distal transverse arch.
  • Non-DKS patients with an initial aortic isthmus (AIsth) z-score < -1 had smaller final AIsth dimensions.
  • Initial reconstruction between z-scores 0 and +1 maintained these dimensions at mid-term follow-up.

Conclusions:

  • Patch augmentation allows proportional aortic growth when initially sized to normal z-scores.
  • Aortic isthmus (AIsth) undersizing is common and linked to higher reintervention rates.
  • Targeted initial aortic sizing, particularly for the AIsth, is crucial for optimal mid-term outcomes and reduced reintervention.