Yasui Procedure with Aberrant Right Subclavian Artery Patch for Interrupted Aortic Arch (Type B)

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Defects

Background:

• Interrupted aortic arch (IAA) repair, particularly with Damus-Kaye-Stansel (DKS) anastomosis, can lead to "gothic arch" formation.
• This anatomical distortion is associated with late hypertension and bronchial compression.
• Aberrant right subclavian artery (RSCA) presence complicates IAA repair.

Purpose of the Study:

• To describe a modified surgical technique for IAA reconstruction in infants with hypoplastic left ventricular outflow tract.
• To evaluate the anatomical outcomes of using a free aberrant RSCA patch for posterior aortic arch reconstruction.

Main Methods:

• A staged Yasui procedure was performed on 2 infants with IAA (type B) and hypoplastic left ventricular outflow tract.
• A free aberrant RSCA was harvested, opened longitudinally, and fashioned into a patch for the posterior aortic arch wall.
• Anterior reconstruction utilized a pulmonary homograft patch.

Main Results:

• Postoperative computed tomography scans showed smooth, rounded aortic arch anatomy in both patients.
• No "gothic arch" formation or signs of bronchial compression were observed.
• The free patch technique demonstrated greater surgical flexibility compared to pedicled flaps.

Conclusions:

• Using a free aberrant RSCA patch is an effective modification for reconstructing the posterior aortic arch in complex IAA cases.
• This technique achieves excellent midterm anatomical results, facilitating subsequent DKS anastomosis and promoting growth.
• It offers a viable alternative to pedicled flaps, enhancing surgical options for IAA repair.