Postoperative aortic isthmus size after arch reconstruction with patch augmentation predicts arch reintervention

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease
• Aortic Arch Reconstruction

Background:

• Reintervention rates following patch-augmented reconstruction for hypoplastic aortic arch (HAA) remain a clinical concern.
• Identifying modifiable risk factors for reintervention is crucial for improving long-term outcomes.

Purpose of the Study:

• To analyze mid-term outcomes of aortic arch reconstruction in patients with HAA.
• To define modifiable risk factors associated with reintervention after this procedure.

Main Methods:

• A retrospective analysis of 338 patients undergoing arch reconstruction (2000-2021), excluding specific techniques.
• Surgical techniques included patch augmentation with coarctectomy (80%), isolated patch aortoplasty (12%), and others (8%).
• Competing risk models were used to assess risk factors for reintervention.

Main Results:

• At a median follow-up of 3.9 years, 10.4% of patients required reintervention.
• Univariate analysis identified isolated patch aortoplasty, aortic homograft use, and postoperative aortic size z-score ≤ -2 as risk factors.
• Multivariable analysis confirmed aortic homograft use (HR 6.29) and isthmus z-score ≤ -2 (HR 10.5) as significant predictors of reintervention.

Conclusions:

• Aortic undersizing during HAA reconstruction leads to a >10% mid-term reintervention rate.
• Achieving adequate postoperative aortic size, particularly the aortic isthmus, is critical for preventing reintervention.