Open-Hybrid Aortic Stent Placement for Recurrent Coarctation in Complex Single Ventricles.

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Interventional Cardiology

Background:

• Recurrent coarctation of the aorta is a significant complication in patients with hypoplastic left heart syndrome (HLHS).
• Timely intervention is crucial to prevent further ventricular dysfunction and atrioventricular valve regurgitation.
• Existing treatment strategies include catheter-based interventions or surgical arch augmentation.

Purpose of the Study:

• To present an innovative open-hybrid surgical technique for managing recurrent coarctation of the aorta in HLHS patients.
• To describe the use of a balloon-expandable stent that allows for future expansion as the patient grows.

Main Methods:

• An open-hybrid surgical approach was employed.
• A balloon-expandable stent was placed in the aortic arch.
• The technique focused on limiting arch dissection to minimize risks.

Main Results:

• The described technique facilitates future stent expansion to accommodate adult size.
• Minimizing arch dissection reduces the risk of injury to the left recurrent laryngeal nerve.
• Shortened anterograde cerebral perfusion time was achieved during the procedure.

Conclusions:

• The open-hybrid surgical technique with a deployable stent provides a promising solution for recurrent coarctation in HLHS.
• This method addresses the challenge of aortic growth in pediatric patients.
• The approach potentially improves safety by reducing surgical risks to critical neural structures and cerebral perfusion.