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DOI: 10.1055/s-0036-1571575
Aortic Arch Reconstruction Using “Autologous Pulmonary Artery Patch” as an Interposition Patch Plasty in Interrupted Aortic Arch and Ventricular Septal Defect
Objective: This retrospective analysis aims to evaluate our experience using autologous pulmonary artery interposition patch plasty as an alternative approach in patients with interrupted aortic arch (IAA) if direct anastomosis technique is not possible.
Patients and methods: Between 2005–2015 nine patients with the diagnosis of IAA (Type A: 2 patients, Type B:7patients) and ventricular septal defect (VSD) were operated using autologous pulmonary interposition patch plasty technique for aortic reconstruction. Five patients were treated initially with hybrid stage 1 approach due to borderline left-sided heart structures for primary repair. As a further operation they underwent to a total correction including IAA repair and VSD closure with a combination of bilateral pulmonary artery de-banding, bilateral pulmonary artery reconstruction and removal of the ductal stent. The remaining four patients underwent to a primary complete repair. In all patients IAA reconstruction was performed under moderate (28–30°C) hypothermic cardiopulmonary by-pass combined with selective cerebral perfusion. While reconstructing the aortic arch, a quadrangular shaped autologous pulmonary artery tissue was harvested from the anterior wall of the main pulmonary artery between the supracommissural level and the ligated ductus arteriosus. The harvested pulmonary autograft was then used to reconstruct the posterior wall of the aortic arch between the aorta ascendens and the aorta descendens. Anterior wall of aortic arch was reconstructed with autologous pericardium. The created defect in the main pulmonary artery was replaced with xenopericardium or with autologous pericardium. 8 patients out of 9 patients could be treated biventricular.
Results: Median follow-up time of the survivors was 58 months (range:1 - 115 months). In-hospital mortality occurred in one patient. There was no late mortality. Freedom from re-intervention and reoperation for aortic arch was %100 at the follow-up period.
Conclusion: In some cases, especially in IAA type B, applying the direct anastomosis technique is sometimes not possible. In this condition, aortic arch reconstruction with interposition of autologous pulmonary patch plasty for the posterior wall can be a good alternative to other techniques, because of the growth potential of the pulmonary artery as a posterior wall and anatomical correction of the arch.