To compare the short- and mid-term clinical and morphological outcomes of autologous pericardial patches (PP) versus pulmonary artery patches (PAP) in neonatal and infant aortic arch reconstruction, highlighting the significance of this comparison in clinical practice.
Key Findings:
Cardiopulmonary bypass and cross-clamp times were significantly longer with PAP (P < 0.001), indicating a potential impact on surgical efficiency.
Early mortality was comparable between PP and PAP cohorts (overall 4.2%; P = 0.698), suggesting similar safety profiles.
10-year freedom from recoarctation was similar for both groups (overall 88.4%; P = 0.958), indicating long-term effectiveness.
An elevated pre-discharge systolic peak velocity >2.48 m/s was a significant indicator of recoarctation (HR, 7.373; P < 0.001), emphasizing the need for careful postoperative monitoring.
PAP produced a larger initial proximal arch-to-ascending aorta diameter ratio (P < 0.001), but both patches showed similar mid-term growth trajectories, suggesting that initial size may not dictate long-term outcomes.
Interpretation:
Both autologous PP and PAP provide comparable clinical and morphological outcomes, with initial geometric relief being more critical than patch selection to prevent late recoarctation. This finding underscores the importance of surgical technique and patient-specific factors.
Limitations:
The study is retrospective and may be subject to selection bias, which could influence the generalizability of the results.
The follow-up duration was limited to a median of 4.0 years, potentially missing late complications or outcomes.
Conclusion:
Autologous PP and PAP yield similar outcomes, emphasizing the importance of achieving optimal initial geometric relief over patch selection in aortic arch reconstruction.
