Off-pump aortic arch repair through a median sternotomy for type B interrupted aortic arch with single ventricle physiology.

BACKGROUND

The aortic arch repair for interrupted aortic arch (IAA) with the hypoplastic ascending aorta through a median sternotomy requires cardiopulmonary bypass (CPB), which is very invasive in neonates and complicates pulmonary artery banding (PAB) is staged repair.

METHODS

A 22-day-old neonate with a type B IAA having a functional single ventricle underwent arch repair and PAB through a median sternotomy without CPB. A partial occlusion clamp could be placed on the ascending aorta without cerebral malperfusion and the descending aorta could be directly anastomosed to the ascending aorta in an end-to-side fashion under stable circulatory condition. Thereafter, the tight PAB was performed with a circumference of 23mm without any difficulty.

RESULTS

The postoperative echocardiogram revealed no stenosis on the anastomotic site and the patient was discharged uneventfully.

CONCLUSION

This approach is effective in neonates with IAA who require staged repair, and least invasive for them.