Comparison Of Autologous Pericardium Patch And Pulmonary Patch For Coarctation Of The Aorta And Hypoplastic Aortic Arch In Infants

Objective:To evaluate the advantages and disadvantages of pericardium patch aortoplasty and pulmonary patch aortoplasty for the treatment of coarctation of the aorta (COA) and hypoplastic aortic arch, and provide a more reasonable surgical choice.Methods:Clinical data of 57 patients who underwent surgical correction for Co A and hypoplastic aortic arch in Fuwai Hospital from January 2009 to December 2014 were retrospectively analyzed. According to different surgical strategies for aortic arch hypoplasia, all the 57 patients were divided into 2 groups. Pericardium patch aortoplasty was performed in 26 patients. Pulmonary patch aortoplasty was performed in 31 patients. During postoperative and follow-up period, the changes of the pressure gradient between the two groups were detected and compared. Results:Two patients died postoperatively (3.5%), one patient died of pulmonary hypertension crisis in pericardium patch group and the other patient died of respiratory distress syndrome in pulmonary patch group. None of the patients in either group had renal failure or neurological complications. There was no significant difference in cardiopulmonary bypass time, aortic clamping time, ventilator time and ICU time between the two groups (P>0.05). Selective cerebral perfusion time of the pericardium patch group was shorter than that of the pulmonary patch group(P<0.05). In pericardial patch group, mean pressure gradient of postoperative was significantly lower than that of preoperative [(9.5±7.5) vs (39.9 ± 15.5) mmHg (1 mmHg=0.133 kPa)] (P<0.05). In pulmonary patch group, mean pressure gradient of postoperative was significantly lower than that of preoperative [(11.8±11.3) vs (39.2 ± 14.5) mmHg] (P<0.05). There was no significant difference in postoperative pressure gradient between the two groups (P<0.05). Fifty-one patients (91%) were followed up, the mean time was 17.6±16.6 months (3-61). In pericardial patch group, six patients had aortic restenosis, of which three patients were undergoing balloon angioplasty and the others were still followed up. In pulmonary patch group, there was six patients suffering aortic restenosis, two patients underwent balloon angioplasty and the others were still followed up. The Kaplan-Meier curves for freedom from restenosis showed pulmonary patch group was superior to pericardial patch group. Conclusion:Both pericardium patch aortoplasty and pulmonary patch aortoplasty are effective surgical methods for CoA and hypoplastic aortic arch. There is no significant difference in the early results, while pulmonary patch is better than pericardium patch during the middle follow-up results.