Recoarctation after Neonatal Hypoplastic Aortic Arch Repair: Impact of Patch Material
Thibault Schaeffer1,2, Marina Huhnke1, Doris Kienmoser1
1German Heart Centre, TUM University Hospital, Department of Congenital and Pediatric Heart Surgery, Bavaria, Germany, Munich.
Background:
Recoarctation remains a frequent complication after neonatal aortic arch repair. This study aimed to identify risk factors for recoarctation, with particular emphasis on the patch material used for aortic enlargement.
Methods:
All neonates who underwent aortic arch repair with patch augmentation through median sternotomy at our institution between 2000 and 2024 were reviewed retrospectively. The primary endpoint was recoarctation, defined as any catheter-based or surgical reintervention on the reconstructed distal aortic arch. Risk factors were assessed using multivariable cause-specific Cox regression, and cumulative incidences of recoarctation and death were estimated using competing-risk methods.
Results:
A total of 597 patients were included (38% female; 61% with single-ventricle physiology; median age and weight at surgery, 8 days and 3.2 kg, respectively). The cumulative incidence of recoarctation was 23% at 1 year. Smaller preoperative aortic arch dimensions (cause-specific hazard ratio [csHR], 0.84 per mm; 95% confidence interval [CI], 0.73-0.97), younger age at surgery (csHR, 0.96 per day; 95% CI, 0.93-0.99), and patch material were independently associated with recoarctation. Compared with glutaraldehyde-fixed autologous pericardium, bovine pericardium (csHR, 2.94; 95% CI, 2.01-4.65) and equine pericardium (csHR, 2.18; 95% CI, 1.36-3.24) were associated with higher recoarctation risk, whereas cryopreserved pulmonary homograft was associated with lower risk (csHR, 0.27; 95% CI, 0.16-0.48).
Conclusion:
Cryopreserved pulmonary homograft and glutaraldehyde-fixed autologous pericardium were associated with a lower incidence of recoarctation and should therefore be preferred over xenograft patches for neonatal aortic arch repair.
