A MODIFIED END-TO-SIDE APPROACH FOR AORTIC ARCH RECONSTRUCTION IN NEONATES YIELDS OUTSTANDING OUTCOMES

Background and Aim: This study focuses on evaluating the outcomes of a modified end-to-side aortic arch reconstruction for treating hypoplastic aortic arch with or without coarctation of the aorta and interrupted aortic arch via sternotomy in infants. Methods: This study retrospectively reviewed 60 infants who underwent modified end- to-side reconstruction at our institution between January 2020 and January 2024. The study evaluated mortality, morbidity and reinterventions. Results: A total of 60 patients (32 males) were included in this study. Mean age at surgery was 49 days. Patients were divided into: group A, arch anomalies with or without ASD and/or VSD; group B (55%) arch anomalies associated with TGA, single ventricle physiology, DORV, CAVC, MV stenosis and subaortic stenosis. Three patients (6.2%) died during postoperative period, all from group B. Incidence of postoperative complications was 30%, wound dehiscence (9%), acute neurological lesions (8%) and vocal cord paralysis (6%). Bronchial compression was not observed in any patient. Three patients required early reoperations due to residual valvular dysfunction. Mean CPB time was 152 minutes, mean aortic cross-clamp time was78 minutes and mean antegrade cerebral perfusion time was 40 minutes. Conclusion: Modified end-to-side technique in neonates is safe and effective with favorable outcomes. This approach reduces the incidence of some common complications by minimizing the tension on the anastomosis, reducing ovalization of the aortic lumen, thereby reducing future reobstruction; it prevents compression on the left bronchus and protects the left recurrent laryngeal nerve from inadvertent injuries. Selective cerebral perfusion is a key factor in minimizing acute brain injuries.