Comparative outcomes of direct anastomosis versus patch repair in neonatal aortic arch reconstruction: Freedom from restenosis and reintervention

Aybala Tongut, Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Zeynep Bengi Eren, Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Mahmut Ozturk, Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Alyssia Venna, Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Mitchell Haverty, Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Arif Selcuk, Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Manan Desai, Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Andrew Waberski, Department of Anesthesiology, Pain, and Perioperative Medicine, Children's National Hospital, Washington, DC, USA.
Can Yerebakan, Division of Cardiothoracic Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Yves d'Udekem, Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Document Type

Journal Article

Publication Date

10-21-2025

Journal

Interdisciplinary cardiovascular and thoracic surgery

Volume

40

Issue

10

DOI

10.1093/icvts/ivaf251

Keywords

Coarctation of the aorta; direct anastomosis; end to end repair; neonatal aortic arch repair; reintervention; restenosis

Abstract

OBJECTIVES: This study compares outcomes of patch repair versus direct anastomosis in neonatal aortic arch repair with the goal of identifying any long-term differences in restenosis, reoperation, and reintervention rates. METHODS: Neonates who underwent aortic arch repair via median sternotomy between 2004 and 2021, using either patch repair or direct anastomosis techniques, were included in this study. Patch materials were glutaraldehyde-treated pericardium and femoral vein homograft. Statistical comparisons included descriptive and bivariable analyses to evaluate patient characteristics, reintervention, reoperation, and restenosis at a 20 mmHg threshold. RESULTS: Seventy-five neonates, who underwent neonatal arch repair using patch technique (n = 53) or direct anastomosis (n = 22) were included in the study. No significant differences in reintervention, reoperation, or restenosis were found between surgical approaches at 20 mmHg threshold (p > 0.13). Patient characteristics such as younger age (p = 0.06), shorter height (p = 0.1), and lower weight (p = 0.2), at the time of surgery were not significant predictors of restenosis. Cardiopulmonary bypass and circulatory arrest times were shorter with direct anastomosis. Ten-year mortality was 11% (n = 8). CONCLUSIONS: There is no clear advantage of either patch or direct anastomosis for neonatal aortic arch repair regarding early- to mid-term outcomes. Patient-specific factors did not appear to be stronger predictors of restenosis risk than the surgical technique employed.

Department

Surgery

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