Modified Norwood Procedure for Tricuspid Atresia, Transposition of Great Arteries, and Hypoplastic Right Arch With Complete Vascular Ring

Neonates with Right Aortic Arch Requiring Arch Reconstruction: A Single-Institution Experience

BACKGROUND

Reconstruction of a right aortic arch (RAA) is rarely required in the newborn period and has rarely been reported.

METHODS

All patients who underwent a RAA repair in the neonatal period from a single institution were retrospectively reviewed. The primary outcome measures included survival, complications, and reintervention.

RESULTS

Between 1984 to 2020, 15 patients were identified. Nine patients (60%) presented with an interrupted aortic arch (IAA), five (33%) with a hypoplastic arch, and one (7%) with anomalous origin of the brachiocephalic vessels. All patients had associated complex congenital heart disease. Median age at surgery was six days (range, 2-29), median weight 3.11 kg (range, 2.5-4.18). Genetic syndromes were prevalent and 77% of IAA patients had DiGeorge syndrome. Surgical techniques included end-to-side (27%), end-to-end (27%) or side-to-side anastomosis (13%) and placement of an interposition graft (7%). 65% required patch augmentation. Median intensive care unit and total hospital length of stay were 20 days (range, 7 - 92) and 28 days (range, 10 - 240), respectively. At median follow-up of 3.97 years (range, 0.19-36), 13 of 15 (87%) patients were alive. Vocal cord paralysis was found in 27%, hemidiaphragm paralysis in 13% and significant airway compression in 27%. Overall, 27% patients required reintervention on the aortic arch; two surgical and two percutaneous balloon dilation.

CONCLUSIONS

RAA reconstruction in the newborn period is rare and associated with complex lesions with an acceptable reintervention rate.