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Charles D Fraser

Publications and source records attributed to Charles D Fraser.

At least 19 recordsLinked to original sources
PubMed2004

Improved early results with the Fontan operation in adults with functional single ventricle.

BACKGROUND: A growing number of adults with functional single ventricles are presenting as candidates for first-time and redo-Fontan operations. This study describes the clinical presentation and early operative results of adults who have undergone Fontan modifications. METHODS: Between July 1995 and April 2003, 23 patients (>18 years old) had Fontan operations. We retrospectively reviewed their perioperative courses. RESULTS: Twenty-three Fontan operations (first-time [n = 8] and redo [n = 15]) were performed with no early or late deaths. No patient has required reoperation. One patient has been listed for orthotopic heart transplantation. The overall mean age is 23 years (18 to 41 years); mean follow-up, 30 months; median postoperative hospital stay, 8 days (4 to 34 days); and median duration of chest tube drainage, 4 days (2 to 12 days). The postoperative New York Heart Association (NYHA) functional class was improved in 22 of 23 patients. Eight first-time Fontan operations (7 of 8 nonfenestrated) were performed; lateral tunnel (n = 7) and extracardiac conduit (n = 1). Two patients had preoperative arrhythmias. New onset arrhythmias (ventricular tachycardia and sinus node dysfunction), requiring treatment, occurred in two patients. Fifteen redo-Fontan operations (all nonfenestrated) were performed; lateral tunnel (n = 5) and extracardiac conduit (n = 10). Fifteen patients had preoperative arrhythmias, thirteen of which had intraatrial reentry tachycardia (IART) and required antiarrhythmic medications. Concomitant intraoperative radiofrequency ablation (RFA) (n = 11) and cryoablation (n = 1) procedures were performed. In the immediate postoperative period, there was IART recurrence in five patients (post-RFA [n = 4] and postcryoablation [n = 1]). At latest follow-up, no patient is being treated with antiarrhythmic medications. Two patients had new onset atrial arrhythmias that required treatment. CONCLUSIONS: The Fontan operation can be performed in adults with minimal morbidity and improved NYHA functional class. New onset arrhythmias requiring treatment are sources of perioperative morbidity. Complete arrhythmia resolution of the preoperative arrhythmia may not be achieved in the immediate postoperative period in redo-Fontan patients. However, modification (intraoperative radiofrequency ablation-right atrial debulking) of the atrial tachycardia circuits in the redo-Fontan patients can result in complete resolution of preoperative atrial tachyarrhythmias at early follow-up.

Adolescent↗
PubMed2004

Anatomic reconstruction for recurrent aortic obstruction in infants and children.

BACKGROUND: Patients undergoing operative repair of aortic obstruction are at a lifelong risk of recurrent obstruction, and there is controversy regarding the optimal surgical technique. We have used an alternative strategy for recurrent aortic obstruction, typically involving anatomic reconstruction by means of a median sternotomy, and describe our techniques and results. METHODS: Twenty-one patients presented with recurrent aortic arch obstruction. Mean age and weight were 7.8 +/- 5.4 years (range, 0.21 to 15.2 years) and 30.6 +/- 21.8 kg (range, 3.6 to 90 kg), respectively. Recurrence involved the aortic arch to some degree in each case, as the mean preoperative transverse aortic arch z score was -2.9 +/- 1.6 (range, -7.0 to 0.1). Thoracotomy was possible in 2 patients, using re-resection with end-to-end anastomosis (n = 1) and patch aortoplasty (n = 1). The remaining 19 patients required median sternotomy, cardiopulmonary bypass, and deep hypothermic circulatory arrest for complete relief of obstruction by aortic arch advancement (n = 10), patch aortoplasty (n = 8), or interposition grafting (n = 1). RESULTS: There was 1 hospital death. Invasive blood pressure monitoring revealed no residual arm-to-leg gradient in 19 patients and a 20-mm Hg gradient in 2 patients. There have been no late deaths. No patients have undergone subsequent aortic intervention, and all are asymptomatic up to 85 months postoperatively. Two patients are currently followed with a 10-mm Hg arm-to-leg blood pressure gradient. CONCLUSIONS: Anatomic reconstruction for recurrent aortic obstruction can be safely accomplished in the majority of patients. We favor median sternotomy because of the ability of establishing cardiopulmonary bypass, the facility of anatomic reconstruction techniques, and the ability to repair concomitant cardiovascular lesions.

Adolescent↗
PubMed2004

Left ventricular inflow obstruction associated with persistent left superior vena cava and dilated coronary sinus.

BACKGROUND: It has previously been suggested that significant dilatation of the coronary sinus can contribute to left ventricular inflow obstruction and is amenable to surgical correction. The purpose of this study was to review our experience with this rare condition. METHODS: Since 1995, 6 patients have undergone coronary sinus reduction for concerns of obstruction with other concomitant intracardiac repairs. Preoperative echocardiography identified a significantly dilated left superior vena cava to the coronary sinus in 5 patients (83%) and an abnormal mitral valve in 4 patients (67%); these resulted in abnormal Doppler inflow patterns. Preoperative cardiac catheterization was performed in 5 patients and revealed increased atrial "a" waves, with a gradient to the left ventricular end-diastolic pressure in each case. At the time of surgery, coronary sinus angioplasty was performed in all patients. RESULTS: There were no deaths, and there was no major morbidity. Follow-up imaging revealed no significant left ventricular inflow obstruction in any patient. CONCLUSIONS: We conclude that dilatation of the coronary sinus can become hemodynamically significant and that coronary sinus angioplasty is a safe and effective technique.

Adolescent↗
PubMed2004

The Warden procedure for partially anomalous pulmonary venous connection to the superior caval vein.

PURPOSE: When there is partially anomalous pulmonary venous connection to the superior caval vein, intracardiac repair alone can result in obstruction. Although the Warden procedure involving translocation of the superior caval vein is commonly performed as an alternative to atriocavoplasty, follow-up of a larger number of patients in the modern era is lacking. We report and discuss the experience of a single institution with the Warden procedure for correction of partially anomalous pulmonary venous connection to the superior caval vein. METHODS: Since 1995, all 16 patients presenting with partially anomalous pulmonary venous connection to the superior caval vein underwent the Warden procedure at a mean age of 7.1 +/- 4.2 years, with a range from 0.2 to 14.3 years, and a mean weight of 24.7 +/- 14.0 kg, with a range from 4.1 to 52.9 kg. There were 9 males and 7 females. In 8 patients, we performed 10 concomitant procedures, including closure of an atrial or ventricular septal defect in 7, and advancement of the aortic arch in the other. RESULTS: There were no deaths, and only one episode of postoperative sinus bradycardia with intermittent junctional rhythm, which resolved spontaneously during temporary atrial pacing. All patients were discharged home in normal sinus rhythm at an average of 4.1 +/- 2.2 days after the procedure, with a range from 2 to 10 days. All are currently in the first grade of the New York Heart Association up to 5.6 years postoperatively. There is currently no evidence of sinus nodal dysfunction, nor obstruction of the superior caval vein, in any patient. CONCLUSION: The Warden procedure for partially anomalous pulmonary venous connection to the superior caval vein produces excellent results, preserves the function of the sinus node, and should be routinely considered for the repair of this lesion.

Adolescent↗
PubMed2004

Neurologic monitoring for special cardiopulmonary bypass techniques.

Low flow hypothermic cardiopulmonary bypass, deep hypothermic circulatory arrest, and regional low-flow cerebral perfusion are special techniques used to facilitate complex intracardiac and aortic surgery in neonates and infants. Each carries a risk of cerebral hypoxia and neurologic morbidity. Neurologic monitoring in the form of near-infrared spectroscopy for cerebral oxygenation, transcranial Doppler ultrasound, and the bispectral index electroencephalogram can monitor the brain during these techniques to determine the minimum acceptable bypass flow rates or maximum acceptable duration of deep hypothermic circulatory arrest. The use of this monitoring has the potential to improve long-term neurologic and developmental outcome.

Cardiopulmonary Bypass↗
PubMed2004

Current expectations for newborns undergoing the arterial switch operation.

BACKGROUND: The arterial switch operation (ASO) represents a remarkable success story in the surgical treatment of cyanotic congenital heart disease. This study is designed to assess recent outcomes after the ASO in babies presenting with transposition of the great arteries (TGA) and Taussig-Bing anomaly (TBA). METHODS: One hundred twenty-five consecutive neonatal and infant ASOs were performed by 2 surgeons at Texas Children's Hospital between July 1, 1995 and October 1, 2003. Patients with TGA and TBA were offered ASO irrespective of patient size and associated cardiac malformations. Primary cardiac diagnoses included TGA with intact ventricular septum (TGA/IVS, n = 79, 63%), TGA with ventricular septal defect (TGA/VSD, n = 37, 30%), and Taussig Bing Anomaly (TBA, n = 9, 7%). RESULTS: With complete follow-up, we observed a 30-day mortality rate of 1.6% (n = 2) with 2 late deaths (1.6%), for an overall actuarial survival rate of 96.3% at 7 years. Although there was a significant incidence of complex coronary ostial origin and branching including single coronary (n = 8, 6.4%) and intramural coronary artery (n = 8, 6.4%), this was not associated with increased operative risk. All patients are fully saturated and NYHA functional class I at latest clinic visit (0.3 to 88.4 months postoperatively). There have been no late coronary events. Of 121 survivors, 7 patients (5.8%) have required cardiovascular reoperation at an average of 15.3 +/-11.7 months postoperatively (range, 3.6 to 30.6 months) for an actuarial freedom from reoperation of 90% at 7 years. CONCLUSIONS: Using current methodologies, the ASO can be performed safely and with a low incidence of need for reoperation on intermediate follow-up. Recent experience indicates operative survival rates approaching 100%.

Cardiac Surgical Procedures↗
PubMed2004

Outcomes of congenital heart surgery patients after extracorporeal life support at Texas Children's Hospital.

The objective of this study was to investigate the outcomes of children with heart failure of various etiologies requiring temporary use of currently available technology in the U.S.A. after extracorporeal life support (ECLS) [left ventricular assist device (LVAD) or extracorporeal membrane oxygenation (ECMO)] at Texas Children's Hospital. Between July of 1995 and October of 2002, 2847 patients underwent congenital heart surgical repairs with the aid of cardiopulmonary bypass at Texas Children's Hospital. During this period, 17 patients required chronic mechanical circulatory assistance with Biomedicus centrifugal pump (n=8) or Thoratec LVAD (n=4), and ECMO (n=5). Six out of 17 patients required ECLS for postcardiotomy heart failure. Seven of the 17 patients had congenital heart disease, six had cardiomyopathy, three had late acute rejection following heart transplantation, and one had myocardial infarction. Twelve patients survived and five patients expired. Six of 12 survivors recovered sufficient cardiac function to allow device removal; and the remaining six patients underwent heart transplantation. Three out of five deaths were ECMO patients. The need for ECLS following repair of congenital heart disease is extremely rare in our institution. The requirement for the use of ECMO confers a significantly higher mortality presumably because of associated combined cardiopulmonary failure. Congenital heart disease appears to be associated with significantly higher mortality.

Adolescent↗
PubMed2004

Changes in respiratory mechanics among infants undergoing heart surgery.

UNLABELLED: Children with excessive pulmonary blood flow (PBF) from congenital heart disease have abnormal respiratory mechanics. Exposure to hypothermic cardiopulmonary bypass (CPB) adversely affects lung function. We designed this study of 106 patients to determine the changes in respiratory mechanics in infants younger than 1 yr undergoing heart surgery. Dynamic respiratory compliance (Cdyn) and total respiratory resistance (Rrs) were measured before surgical incision, after sternal closure in the operating room, and after arrival in the intensive care unit. The following data were recorded: age, weight, preoperative pulmonary infiltrates, preoperative mechanical ventilation, evidence of increased PBF before surgery, duration of CPB, duration of aortic cross-clamp, duration of deep hypothermic circulatory arrest, use of steroids, and volume of ultrafiltrate removed. Repeated-measures analysis of variance with covariate analysis was used to determine the effect of each covariate on Cdyn and Rrs at the three time periods. Rrs improved after cardiac surgery correcting increases in PBF, and this was most pronounced in neonates. Among infants with normal or reduced PBF, cardiac surgery with CPB led to a reduction in Cdyn. We consider that the benefits of surgical correction of pulmonary overcirculation outweigh the negative effects of CPB on respiratory mechanics. IMPLICATIONS: The benefits of surgical correction of pulmonary overcirculation outweigh the negative effects of cardiopulmonary bypass on respiratory mechanics in infants.

Aging↗
PubMed2004

Is bilateral monitoring of cerebral oxygen saturation necessary during neonatal aortic arch reconstruction?

UNLABELLED: In this study, we measured cerebral oxygenation in both cerebral hemispheres by using near-infrared spectroscopy before, during, and after regional low-flow cerebral perfusion (RLFP) to determine whether bilateral monitoring was necessary. Neonates undergoing aortic arch reconstruction with RLFP were studied. The bilateral regional cerebral oxygenation index was measured and recorded at 1-min intervals during the following periods: 1) before bypass, 2) during bypass before RLFP, 3) during RLFP, 4) on bypass after RLFP, and 5) post-bypass. Before bypass and on bypass before RLFP, the correlation (r = 0.979 and 0.852) and agreement (mean bias, right versus left, 0 and +2) between hemispheres were excellent. During RLFP, however, correlation (r = 0.35) and agreement (mean bias of the right versus left side, +6.3) worsened and only partially returned to baseline values after RLFP. Nine of 19 patients had sustained differences in cerebral oxygen saturation of >10%, always with the left side values less than the right. Bilateral monitoring detects desaturation in the left cerebral hemisphere during RLFP. The long-term consequences of lower saturations on the left side of the brain are unclear. IMPLICATIONS: Left-sided cerebral hemisphere oxygen saturation, measured with near-infrared spectroscopy, was less than right-sided cerebral oxygen saturation during regional low-flow cerebral perfusion used for neonatal aortic arch reconstruction.

Aorta, Thoracic↗
PubMed2004

Limiting circulatory arrest using regional low flow perfusion.

Deep hypothermic circulatory arrest (DHCA) is commonly used for neonatal cardiac surgery. However, prolonged exposure to DHCA is associated with neurologic morbidity. The Norwood operation and aortic arch advancement are procedures that typically require DHCA during surgical correction. Regional low flow perfusion (RLFP) can be used to limit or exclude the use of circulatory arrest. This technique involves cannulation of the innominate or subclavian artery using a Gore-Tex graft, allowing isolated cerebral perfusion. Data was collected in 34 patients undergoing either neonatal aortic arch reconstruction or the Norwood procedure using RLFP. All patients had two arterial pressure monitors using either the umbilical or femoral artery catheters and radial or brachial catheters. Adequacy of perfusion was determined using cerebral saturation, blood flow velocity, mean arterial pressures, and arterial blood gas results. Cerebral saturation and blood flow velocity were monitored using the near-infrared spectroscopy (NIRS) (INVOS 5100, Somanetics Corp, Troy, MI) and a transcranial Doppler pulse-wave ultrasound (TCD) (EME Companion, Nicolet Biomedical, Madison, WI), respectively throughout the entire bypass period. Blood gases were monitored using a point of care blood gas analyzer (Gem Premier, Mallinckrodt Sensor System, Inc., Ann Arbor, MI). Data collected revealed total bypass times for repair between 69-348 min, with a mean of 180 min. Regional low flow perfusion times lasted between 6-158 min, with an average of 50 min., and DHCA times ranged from 0-66 min, with a mean of 19 min. The perfusion techniques used allowed patient clinical data to remain consistent throughout the cardiopulmonary bypass period, regardless of lower flows (Figure 1) The 30-day postoperative mortality rate was 2.9 %, with no evidence of neurologic injury during follow up. In conclusion, regional low flow cerebral perfusion might benefit patients by limiting the use of circulatory arrest during cardiac surgery. Further study is necessary to evaluate patient outcomes, comparing regional cerebral perfusion and circulatory arrest techniques.

Anastomosis, Surgical↗
PubMed2003

Mediastinitis after pediatric cardiac surgery: a 15-year experience at a single institution.

BACKGROUND: The spectrum of sternal wound infections after cardiac surgery ranges from superficial infections to a deep sternal infection known as mediastinitis. Mediastinitis is a rare but clinically relevant source of postoperative morbidity and mortality in adult and pediatric patients after cardiac surgery. METHODS: We retrospectively identified all patients diagnosed with mediastinitis after cardiac surgery from January 1987 to December 2002 (17 patients/7,616 surgeries = 0.2%). Demographic data, cardiac diagnosis, cardiac surgery, hospital length of stay, associated medical diagnosis, and surgical treatment for mediastinitis were collected. RESULTS: Fifteen pediatric patients (age < 18 years) were diagnosed with mediastinitis (mean age at diagnosis 37.5 months, range 21 days to 17 years. The median postoperative day of diagnosis was 14 days (6 to 50 days). The most common organism was Staphylococcus species (n = 9). Six patients had an associated bacteremia. The median hospital length of stay for all patients was 42.5 days (range 16 to 163 days). The hospital mortality was 1 of 15 (6%). Each patient was treated with intravenous antibiotics; sternal debridement; and rectus abdominus flap reconstruction (n = 7), pectoralis muscle flap reconstruction (n = 3), omentum reconstruction (n = 1), or primary sternal closure (n = 4). Three patients have undergone redo-sternotomy with orthotopic heart transplantation, bidirectional cavopulmonary anastomosis, and replacement of a right ventricle to pulmonary artery homograft. CONCLUSIONS: Timely diagnosis, aggressive sternal debridement, and liberal use of rotational muscle flaps can potentially minimize the morbidity and mortality in pediatric postoperative cardiac patients. Subsequent redo-sternotomy has not been problematic.

Adolescent↗
PubMed2003

Regional low-flow perfusion provides comparable blood flow and oxygenation to both cerebral hemispheres during neonatal aortic arch reconstruction.

OBJECTIVE: The aim of this study was to measure cerebral oxygenation, cerebral blood volume index, and cerebral blood flow velocity values in both cerebral hemispheres before, during, and after regional low-flow cerebral perfusion for neonatal aortic arch reconstruction and to test the hypothesis that cerebral blood volume index measured by near infrared spectroscopy correlates with cerebral blood flow velocity measured by transcranial Doppler ultrasonography. METHODS: Bilateral near infrared spectroscopy and transcranial Doppler ultrasonography sensors were placed, and values were recorded immediately before, during, and after regional low-flow cerebral perfusion at 18 degrees C. Cerebral oxygen saturations, cerebral blood flow velocities, and cerebral blood volume index values were compared by Mann-Whitney U test. Correlations between values of cerebral blood volume index and cerebral blood flow velocity were tested with Spearman rank order correlation. RESULTS: Twenty patients were studied. Median cerebral oxygen saturations for the right and left sides were 95% and 95% before regional low-flow cerebral perfusion, 95% and 87% during regional low-flow cerebral perfusion (P =.054), and 93% and 94% after regional low-flow cerebral perfusion. Median cerebral blood flow velocity values did not change during regional low-flow cerebral perfusion. Cerebral blood volume index exhibited a poor correlation with cerebral blood flow velocity. CONCLUSIONS: Regional low-flow cerebral perfusion provides comparable blood flows and oxygenation to both cerebral hemispheres. Transcranial Doppler ultrasonography is recommended as a corroborative method with near-infrared spectroscopy to guide flow during regional low-flow cerebral perfusion, because cerebral blood volume index does not correlate with cerebral blood flow velocity.

Aorta, Thoracic↗
PubMed2003

Use of near-infrared spectroscopy to monitor regional cerebral oxygen saturation during infrarenal aortic crossclamping in piglets.

PURPOSE: The hemodynamic changes induced by infrarenal aortic crossclamping have been well documented, but the effects of such crossclamping on cerebral perfusion are unknown. To investigate these effects, we used near-infrared spectroscopy (NIRS) to monitor regional cerebral oxygen saturation (rSO2) during infrarenal aortic crossclamping in a piglet model. METHODS: The study involved 19 piglets, each weighing 7.8 +/- 1 kg. The NIRS sensor was placed on each animal's forehead. General anesthesia was induced, and the infrarenal abdominal aorta was mobilized through a laparotomy. After heparin (1 mg/kg) was administered, crossclamps were applied proximally and distally. A 2 mm segment was resected from the proximal aortic stump, and an aorto-aortic anastomosis was performed. RESULTS: Crossclamping lasted for 30.6 +/- 6.7 min. Between the time of baseline measurement and clamp application, the rSO2 did not decrease significantly (65.4%+/- 8.9% vs. 62.4%+/- 7.8%). However, significant decreases in the rSO2 occurred between baseline measurement and clamp removal (65.4%+/- 8.9% vs. 55.7%+/- 8.9%; P<0.01), between baseline measurement and the end of surgery (65.4%+/- 8.9% vs. 57.7%+/- 7.5%; P<0.01), and between clamp application and removal (62.4%+/- 7.8% vs. 55.7%+/- 8.9%; P<0.01). At these same intervals, no intergroup differences occurred in the temperature, heart rate, or mean arterial pressure. CONCLUSION: Infrarenal aortic crossclamping significantly decreases the rSO2. NIRS, which has the advantages of being non-invasive and continuous, may be useful for monitoring this variable intraoperatively.

Analysis of Variance↗
PubMed2003

Novel cerebral physiologic monitoring to guide low-flow cerebral perfusion during neonatal aortic arch reconstruction.

OBJECTIVE: This study was undertaken to describe the combined measurement of cerebral blood flow velocity and cerebral oxygen saturation as a guide to bypass flow rate for regional low-flow perfusion during neonatal aortic arch reconstruction. METHODS: Data were prospectively collected from 34 patients undergoing neonatal aortic arch reconstruction with regional low-flow perfusion. Cerebral oxygen saturation and blood flow velocity were measured by near-infrared spectroscopy and transcranial Doppler ultrasonography, respectively, throughout cardiopulmonary bypass. After cooling to 17 degrees C to 22 degrees C, baseline values of cerebral oxygen saturation and blood flow velocity were recorded during full-flow bypass. Regional low-flow perfusion was instituted for aortic arch reconstruction, and bypass flow rate was adjusted to maintain cerebral oxygen saturations and blood flow velocities within 10% of baseline recorded during cold full-flow bypass. Cerebral oxygen saturations and blood flow velocities were recorded again after repair during full-flow hypothermic bypass. Bypass flow during regional low-flow perfusion was recorded, as were arterial pressure and blood gas data. One-way repeated measures analysis of variance was used to determine differences in values during regional low-flow perfusion relative to baseline and after perfusion. RESULTS: A mean bypass flow of 63 mL/(kg x min) was required to maintain cerebral oxygen saturations and blood flow velocities within 10% of baseline. Mean arterial pressure had a poor correlation with the required bypass flow rate (r(2) = 0.006 by linear regression analysis). Fourteen of 34 patients had a cerebral oxygen saturation of 95% during regional low-flow perfusion, placing them at risk for cerebral hyperperfusion if the cerebral oxygen saturation had been used alone to guide bypass flow. Pressure was detected in the umbilical or femoral artery catheter (mean 12 mm Hg) in all patients during regional low-flow perfusion. CONCLUSIONS: Cerebral blood flow velocity, as determined by transcranial Doppler ultrasonography, adds valuable information to cerebral oxygen saturation data in guiding bypass flow during regional low-flow perfusion. Its most important use may be prevention of cerebral hyperperfusion during periods with high near-infrared spectroscopic saturation values.

Analysis of Variance↗
PubMed2002

Aortic arch advancement: the optimal one-stage approach for surgical management of neonatal coarctation with arch hypoplasia.

BACKGROUND: The optimal surgical treatment for neonatal coarctation with aortic arch hypoplasia (NCoAo/AAH) is controversial. Important long-term concerns include arch growth. We report our results obtained with a one-stage radical approach of coarctectomy and aortic arch advancement for NCoAo/AAH. METHODS: From June 1995 to December 2000, 65 newborns with NcoAo/AAH underwent coarctectomy and aortic arch advancement via a median sternotomy under deep hypothermic circulatory arrest. Patients were classified by diagnosis: group 1, isolated NCoAo/AAH (n = 13); group 2, NCoAo/AAH with ventricular septal defect (n = 20); and group 3, NCoAo/AAH with complex cardiac lesions (n = 32). RESULTS: The study population included 36 boys and 29 girls. Mean age was 13 +/- 1.7 days (range 1 to 43 days). Mild to moderate left ventricular outflow tract obstruction was present in 15 patients. Mean body weight was 3.4 +/- 0.1 kg (range 1.6 to 5 kg). Eight babies were premature. The mean Z value for the aortic arch was -4 +/- 0.3 (range -2 to -4.5) and for the isthmus -4.5 +/- 0.2 (range -3 to -7). Mean deep hypothermic circulatory arrest time was 28 +/- 2 minutes (range 14 to 60 minutes). Mean intensive care unit stay was 6 +/- 1 days (range 2 to 30 days). There were three early deaths (all in groups 2 and 3) and two late deaths (in group 3) (5-year actuarial survival, 91% +/- 7.9%). There was one recurrence (5-year actuarial freedom from recurrence, 98% +/- 4%). Peak Doppler velocity across the arch in the remaining patients was 1 +/- 0.1 m/s (range 0 to 2.2 m/s). CONCLUSIONS: Coarctectomy and aortic arch advancement is the optimal surgical method for management of NCoAo/AAH. It has low operative morbidity and mortality and a very low incidence of recoarctation or arch obstruction.

Aorta, Thoracic↗