Thorac Cardiovasc Surg 2018; 66(S 01): S1-S110
DOI: 10.1055/s-0038-1627867
Oral Presentations
Sunday, February 18, 2018
DGTHG: Congenital - Univentricular Heart
Georg Thieme Verlag KG Stuttgart · New York

Mid-term Results of Aortic Arch Reconstruction at 121 Comprehensive Stage II Procedure after Hybrid Palliation for Hypoplastic Left Heart Syndrome

U. Yörüker
1   Kinderherzzentrum, Kinderherzchirurgie und Angeborene Herzfehler, Justus Liebig Universität, Giessen, Germany
,
K. Valeske
1   Kinderherzzentrum, Kinderherzchirurgie und Angeborene Herzfehler, Justus Liebig Universität, Giessen, Germany
,
M. Müller
2   Kinderherzzentrum, Kinderherzanästhesie, Justus Liebig Universität, Giessen, Germany
,
B. Sen-Hild
1   Kinderherzzentrum, Kinderherzchirurgie und Angeborene Herzfehler, Justus Liebig Universität, Giessen, Germany
,
A. Sprengel
1   Kinderherzzentrum, Kinderherzchirurgie und Angeborene Herzfehler, Justus Liebig Universität, Giessen, Germany
,
C. Jux
3   Kinderherzzentrum, Kinderkardiologie, Justus Liebig Universität, Giessen, Germany
,
H. Akintürk
1   Kinderherzzentrum, Kinderherzchirurgie und Angeborene Herzfehler, Justus Liebig Universität, Giessen, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
22 January 2018 (online)

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Objective: This study aims to analyze the results of aortic arch reconstruction at Comprehensive stage II for hypoplastic left heart syndrome (HLHS).

Methods: Between June 1998 and April 2017, 154 patients with the diagnosis of HLHS and variants were palliated with hybrid procedure (bilateral pulmonary artery banding and ductal stenting). Until now 121 patients received a comprehensive stage II palliation. Aortic arch reconstruction at comprehensive stage II is performed with selective cerebral perfusion at 28°C body temperature under cardioplegic arrest. On-beating heart aortic arch reconstruction was performed when the ascending aorta is above 4mm of size. For beating-heart aortic arch reconstruction, selective coronary perfusion was combined with selective cerebral perfusion. During arch reconstruction, ductal tissue with ductal stent and coarctation segment was totally excised. Posterior wall of the descending aorta and distal arch is end-to-end anastomosed. After performing a classical Norwood anastomose, anterior wall augmentation was performed with curved xenoperikard patch since 2008.

Results: Early mortality was seen in 8 patients (6.6%). There was no operative mortality at the last 61 consecutive patients. Late mortality was observed in 3 patients (2.5%) at the interstage period before Fontan completion. Three patients received heart transplantation at the interstage period. Median follow-up of survivors is 7 years (0.6–18.5 years). In 1 patient (%0.8) cerebral bleeding and in 2 patients (%1.6) cerebral infarction was observed. All 3 patients survived without any neurological sequels. Reoperation for aorta was needed in 2 patients (1.7%) and 15 patients (13%) required catheter intervention for aorta at the follow-up time.

Conclusion: The results of this largest single center experience with Comprehensive stage II for HLHS indicate that, using our technique aortic arch reconstruction at comprehensive stage II can be performed with low mortality and acceptable morbidity rates.