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

U. Yörüker; K. Valeske; M. Müller; B. Sen-Hild; A. Sprengel; C. Jux; H. Akintürk

doi:10.1055/s-0038-1627867

The Thoracic and Cardiovascular Surgeon, Table of Contents

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

Authors

U. Yörüker

¹Kinderherzzentrum, Kinderherzchirurgie und Angeborene Herzfehler, Justus Liebig Universität, Giessen, Germany
K. Valeske

¹Kinderherzzentrum, Kinderherzchirurgie und Angeborene Herzfehler, Justus Liebig Universität, Giessen, Germany
M. Müller

²Kinderherzzentrum, Kinderherzanästhesie, Justus Liebig Universität, Giessen, Germany
B. Sen-Hild

¹Kinderherzzentrum, Kinderherzchirurgie und Angeborene Herzfehler, Justus Liebig Universität, Giessen, Germany
A. Sprengel

¹Kinderherzzentrum, Kinderherzchirurgie und Angeborene Herzfehler, Justus Liebig Universität, Giessen, Germany
C. Jux

³Kinderherzzentrum, Kinderkardiologie, Justus Liebig Universität, Giessen, Germany
H. Akintürk

¹Kinderherzzentrum, Kinderherzchirurgie und Angeborene Herzfehler, Justus Liebig Universität, Giessen, Germany

Abstract

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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.