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DOI: 10.1055/s-2006-925687
Biological implants as therapeutic option for mid and distal arch stenosis in children
Introduction: In the past reconstruction of coarctations and interrupted arch was done using non-biological interposition grafts. Lack of growth potential and inability to resolve problems with catheter intervention remain a major concern. This study describes our experience with this surgical challenging group of children with a trend to a more definite solution.
Methods: Between June 2003 and September 2005, 12 patients (3 mo–17 yrs) underwent surgical correction for mid and distal arch problems. Five out of 12 patients had interposition grafts (6–8mm) for diagnoses like coarctation and interrupted arch. Other patients had non-biological patches, not successfully amenable to catheter interventions. All patients were operated through a midsternal approach with hypothermic circulatory arrest and antegrade cerebral perfusion. In all patients it was possible to re-achieve a native tissue connection at some point and bovine pericardium was used to enlarge the other areas. In 2 patients a hybrid approach was used, whereas, one patient received an aortic auto-transplantation. Left pulmonary branch transsection was necessary in one patient.
Results: There was no mortality. Follow-up ranges from 1 to 27 months, with, up until now, no signs of re-stenosis. No other complications like bronchial obstruction or neurological sequelae, central or peripheral, were met.
Conclusion: Although interposition grafts are rarely used currently, they still exist in earlier operated patients. In stead of continuing to replace the grafts, the better solution is re-establishing a native continuity with the use of biological material, thereby offering a trend to a definite solution with a more prosperous outlook for the future.