Contemporary results of surgical repair of recurrent aortic arch obstruction

Background There is a paucity of data on the current outcomes of surgical intervention for recurrent aortic arch obstruction (RAAO) after initial aortic arch repair in children. The goal of this study is to report the long-term results in these patients. Methods All patients undergoing surgical intervention for RAAO at Texas Children's Hospital from 1995 to 2012 were included. The cohort was divided into four groups based on initial procedure: (1) simple coarctation repair, (2) Norwood procedure, (3) complex congenital heart disease, and (4) interrupted aortic arch. Results A total of 48 patients age 9 months (range, 22 days to 36 years) underwent 49 procedures for RAAO. All patients had an anatomic repair consisting of either patch aortoplasty (n = 27, 55%), aortic arch advancement (n = 8, 16%), sliding arch aortoplasty (n = 6, 12%), placement of an interposition graft (n = 2, 17%), reconstruction with donor allograft (n = 4, 8%), extended end-to-end anastomosis (n = 1, 2%), or redo Norwood-type reconstruction (n = 1, 2%). Most procedures (n = 46, 94%) were performed through a median sternotomy using cardiopulmonary bypass. At a median follow-up of 6.1 years (range, 9 days to 17 years), only 2 patients required surgical or catheter-based intervention for RAAO. Hypertension was present in 10% of patients at last follow-up. There were no neurologic or renal complications. There was 1 perioperative death after an aortic arch advancement in group 1. Four other patients have died during follow-up, none of the deaths related to RAAO. Conclusions Anatomic repair of RAAO is a safe procedure associated with low morbidity and mortality, and low long-term reintervention rates.