Review Article| Volume 26, P81-88, 2023

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Strategies for Complex Reoperative Aortic Arch Reconstruction in Patients With Congenital Heart Disease

  • William C. Frankel
    Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
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  • Eric E. Roselli
    Address correspondence to: Eric E. Roselli, MD, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, Desk J4-1, Cleveland, OH 44195.
    Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH

    Aorta Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH

    Adult Congenital Heart Disease Center, Heart, Vascular and Thoracic Institute, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH

    Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
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Published:February 02, 2023DOI:
      Aortic dilation is common in patients with congenital heart disease including those with a bicuspid aortic valve, connective tissue disease, coarctation of the aorta, and conotruncal defects. In addition, neo-aortic dilation has been described in patients after aortic reconstruction including the Norwood procedure, the arterial switch operation, and the Ross procedure. Although aortic catastrophe is rare in patients with congenital heart disease, common pathologic endpoints in these patients likely manifest with similar aortic tissue behavior. A lifelong care model with similar indications for surveillance and prophylactic repair to other more common aortopathies is therefore warranted. Still, reoperative aortic arch reconstruction in these patients is often a complex and high-risk endeavor, and in all cases, a tailored and adaptable plan ensuring adequate myocardial and cerebral protection with appropriate rescue measures is paramount. A surgical team taking on these challenging cases should possess an armamentarium of open, hybrid, and endovascular techniques which can be individualized to a patient's unique anatomy, surgical history, and concomitant lesions as well as the team's measured outcomes and experience.



      B-SAFER (Branched stented anastomosis frozen elephant trunk repair), MATADORS (Multidisciplinary Study of Ascending Tissue Characteristics and Hemodynamics for the Development of Novel Aortic Stentgrafts)
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