Results of aortic arch reconstruction in neonates and infants

  • Dr Lotfi Ben Mime, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany, Germany
  • Dr Mathias Emmel, Pediatric Cardiology, University of Cologne, Germany
  • U Trieschmann, Department of Anesthesiology, University of Cologne, Cologne, Germany, Germany
  • N Sreeram, Pediatric Cardiology, University of Cologne, Cologne, Germany, Germany
  • K Brockmeier, Pediatric Cardiology, University of Cologne, Cologne, Germany, Germany
  • G Bennink, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany, Germany

    • Objectives: from June 2003 to September 2006, 38 arch augmentation procedures (29 Norwood I and 9 IAA) have been performed using the standard augmentation of the aortic arch with heterologous pericardium. We evaluated and compared the results of heterologous equine pericardium (n=7) versus bovine pericardium (n=31) (mean follow-up = 38 months). Material and
    Methods: All patients were operated in the standard way using heterologous pericardium to enlarge the aortic arch. The first 7 patients received equine heterologous pericardium, and in the last 31 patients bovine pericardium was used. No other change in surgical technique or suture material was done.
    Results: The group reconstructed with equine heterologous pericardium showed restenosis in all 7 cases (100%). Stenosis was located in the coarctation area requiring balloon intervention (5) and subsequent reoperation (3), in the aortic arch requiring reoperation (1), and in the pulmonary region (1) with the need for balloon dilation. The second group with bovine pericardium showed restenosis in 7 out of 31 cases (23%). Those were treated with balloon dilation only. The difference in restenosis between equine and bovine pericardium was statistically significant (p<0.004).
    Conclusions: The change from equine to bovine heterologous pericardium improved the freedom of reintervention and reoperation. The thicker aspect of equine pericardium and the tendency to shrink may explain for the difference in outcome. On the basis of these results we recommend the usage of bovine heterlogous pericardium for aortic arch reconstruction in neonates and infants.