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Ann Thorac Surg 1999;67:528-531
© 1999 The Society of Thoracic Surgeons

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Original Articles

Extended end-to-end repair and enlargement of the entire arch in complex coarctation¹

^a Departments of Pediatrics and Thoracic-Cardiovascular Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois, USA

Accepted for publication July 21, 1998.

Address reprint requests to Dr Vitullo, Division of Pediatric Cardiology, Loyola University Medical Center, 2160 South First Ave, Maywood, IL 60153

Background. Treatment of hypoplasia of the entire arch in coarctation is a surgical challenge. The current approaches have technical difficulties, high recurrence rates, and increased morbidity and mortality.

Methods. Over a 14-month period, a combined extended end-to-end repair with patch enlargement of the concavity of the entire arch was performed in 6 neonates and 1 infant. Through a midsternotomy and using cardiopulmonary bypass and hypothermia, extended end-to-end repair was performed initially leaving the proximal anastomosis open. The enlarging polytetrafluoroethylene patch was then sutured starting at the incised descending aorta distal to the extended end-to-end repair and continued retrogradely through the transverse arch to the ascending aorta proximal to the aortic cannulation site. One neonate had a patent ductus arteriosus and another had ventricular septal defect closure. One neonate had arterial switch and 3 had Norwood-type procedures performed with the enlarging patch extended to the pulmonary artery anastomosis. The remaining infant had arch enlargement performed after an arterial switch procedure and extended end-to-end repair.

Results. All patients did well and showed no residual gradient up to 1 year follow-up. Two patients successfully had bidirectional Glenn shunt at 9 months of age, and one had closure of residual arterial septal defect at 8 months of age.

Conclusion. The combined extended end-to-end repair and arch enlargement procedure should minimize recurrence rates because of a tension-free enlargement of the entire aortic arch and elimination of the coarctation ridge and ductile tissues. Combined with the arterial switch and Norwood-type procedures, the approach results in a large neoaorta.

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