Novel Methods and Considerations for Addressing Aortic Arch Hypoplasia and Coarctation

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Numerous surgical approaches have been proposed to treat aortic arch hypoplasia (Figures 1&2). These repairs can vary based upon patient age (i.e. neonatal vs larger child), and therefore the mobility of the aorta. Most repairs can be classified into two categories - those that incorporate a patch and those that do not. The decision between repairs remains largely experiential, rather than empirical, due to the limited number of reported outcomes. We report early outcomes from a novel surgical paradigm for arch hypoplasia utilizing a beating-heart, modified aortic arch advancement (with anterior patch, Figure 1B) for all neonates and a beating-heart, sliding arch aortoplasty (all-autologous repair, Figure 2) for all children beyond infancy. Additionally, we present computational fluid dynamic (CFD) modeling data to better understand the hemodynamic consequences associated with a patch utilization during neonatal aortic arch advancement (Figure 3).

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