Abstract
OBJECTIVES: This study compares outcomes of patch repair versus direct anastomosis in neonatal aortic arch repair with the goal of identifying any long-term differences in restenosis, reoperation, and reintervention rates. METHODS: Neonates who underwent aortic arch repair via median sternotomy between 2004 and 2021, using either patch repair or direct anastomosis techniques, were included in this study. Patch materials were glutaraldehyde-treated pericardium and femoral vein homograft. Statistical comparisons included descriptive and bivariable analyses to evaluate patient characteristics, reintervention, reoperation, and restenosis at a 20 mmHg threshold. RESULTS: Seventy-five neonates, who underwent neonatal arch repair using patch technique (n = 53) or direct anastomosis (n = 22) were included in the study. No significant differences in reintervention, reoperation, or restenosis were found between surgical approaches at 20 mmHg threshold (p > 0.13). Patient characteristics such as younger age (p = 0.06), shorter height (p = 0.1), and lower weight (p = 0.2), at the time of surgery were not significant predictors of restenosis. Cardiopulmonary bypass and circulatory arrest times were shorter with direct anastomosis. Ten-year mortality was 11% (n = 8). CONCLUSIONS: There is no clear advantage of either patch or direct anastomosis for neonatal aortic arch repair regarding early- to mid-term outcomes. Patient-specific factors did not appear to be stronger predictors of restenosis risk than the surgical technique employed.