Aortic arch uncrossing in neonates and young infants: A case series

Neonates diagnosed with a circumflex aortic arch and coarctation must undergo early repair. Complete surgical correction of this lesion involves an arch repair with an uncrossing procedure performed during the first few months of life. Little is known about outcomes in neonates undergoing surgery for this lesion. We reviewed our experience with the aortic uncrossing procedure in neonates and young infants.

A retrospective review of all patients undergoing aortic uncrossing at a single center between January 2015 and November 2024 was performed. Data reviewed included demographics, echocardiography, and cross-sectional imaging studies.

Four neonates who underwent an aortic uncrossing procedure were identified. All had a right arch with a circumflex aorta descending in the left hemithorax. Age ranged from 7 to 46 days, and weight ranged from 2.8 to 4.5 kg. Aortic arch translocation and uncrossing were performed under circulatory arrest with antegrade cerebral perfusion. Two patients required patch augmentation of the anastomosis. Three out of 4 patients had left vocal cord dysfunction. The length of stay ranged from 29 to 89 days. One patient required a second cardiac operation unrelated to the original surgery. All 4 patients are doing well at follow-up (range, 5 months-9 years).

The aortic uncrossing procedure can safely be performed as part of a neonatal arch reconstruction with excellent results.