Thorac Cardiovasc Surg 2012; 60 - PP35
DOI: 10.1055/s-0031-1297682

Is the re-coarctation rate in neonatal arch enlargement related to the material used?

A Kroener 1, U Trieschmann 2, N Sreeram 3, K Brockmeier 3, G Bennink 1
  • 1Heart Center/University of Cologne, Dep. of Cardiothoracic Surgery, Cologne, Germany
  • 2Heart Center/University of Cologne, Intensive Care Medicine and Anaesthesiology, Cologne, Germany
  • 3Heart Center/University of Cologne, Pediatric Cardiology, Cologne, Germany

Objectives: There seems to be a difference in the re-coarctation incidence after neonatal aortic arch enlargements depending on the material applied. Three different materials were used, equine and bovine pericardium and pulmonary homograft patches, and their re-intervention incidence rates were compared. All patients were operated using the same technique and same surgeons. The only variable was the material applied for the arch enlargement. The ductal tissue material was always completely removed.

Methods: From June 2003 until March 2011 all surgical procedures were retrospectively reviewed with their outcome to identify the difference in materials used for procedures involving aortic arch enlargement, eg. in Norwood procedures and arch enlargements for hypoplastic arches. The cardiology re-interventions in these patients were looked after and correlated with the primary procedure and material used.

Results: From the 121 neonatal arch enlargements there were 3 groups. Group 1: equine pericardium, used in only 9 patients. Group 2: bovine pericardium, used in 63 patients. Group 3: pulmonary homograft material, used in 49 patients. In group 1 the incidence of re-intervention was 9 out of 9 patients; group 2 from the 63 patients 17 needed a re-intervention and in group 3 there were 4 re-intervention out of 49 patients. The re-interventions consisted in the majority of the cases of a balloon dilation, however, a minority needed a surgical re-intervention to solve the problem with either a separate surgical intervention or a combined intervention at the next scheduled operation eg. Norwood II stage repair. Comparing group 1 with 2 there was a statistical significance in favor of group 2 (p=0.0012927); group 1 versus 3 was statistical significance (p=0.000263) and group 2 versus 3 there was a statistical significant difference in favor of group 3 (p=0.027019)

Conclusions: In neonatal arch enlargements the primary choice of material used for enlarging the arch should be pulmonary homograft material based on these findings. Since this material is not always readily available a good second best in this study is bovine pericardium.