Bovine arch anatomy influences recoarctation rates in the era of the extended end-to-end anastomosis.
OBJECTIVES
Arch branching has never been shown to influence recoarctation after extended end-to-end anastomosis via thoracotomy, yet in each study bovine arch identification is grossly underreported. This study aims to (1) assess chart review reliability in bovine arch identification; (2) determine recoarctation risk with a bovine arch; and (3) explore an anatomic explanation for recurrent arch obstruction based on arch anatomy.


PATIENTS
A total of 49 consecutive patients underwent thoracotomy with extended end-to-end aortic coarctation repair at a single institution (2007-2012).


METHODS
Echocardiograms from these patients were reviewed for arch anatomy and compared with the echocardiographic reports. Recurrent arch obstruction was defined as an echocardiographic gradient across the repair of 20 mm Hg or greater. For cases with angiographic images (n = 17), a scaled clamping distance between the left subclavian artery and the maximal proximal clamp location on orthogonal projections was then calculated across arch anatomies.


RESULTS
Chart review identified 6.1% (3/49) of patients with a bovine arch compared with 28.6% (14/49) on targeted image review. A total of 28.6% (4/14) of patients with a bovine arch had a follow-up gradient of 20 mm Hg or greater. Only 5.7% (2/35) of patients with normal arch branching had a follow-up gradient of 20 mm Hg or greater. The mean clamping index was significantly diminished in patients with bovine arch anatomy.


CONCLUSIONS
Arch anatomy often goes undocumented on preoperative imaging, yet children undergoing extended end-to-end repair with bovine arch anatomy are at a significantly increased risk of recoarctation. This may be due to a reduced clampable distance to facilitate repair. These results should be considered in the preoperative assessment, parental counseling, and surgical approach for children with discrete aortic coarctation.
['Turek|Joseph W|JW|', 'Conway|Brian D|BD|', 'Cavanaugh|Nicholas B|NB|', 'Meyer|Alex M|AM|', 'Aldoss|Osamah|O|', 'Reinking|Benjamin E|BE|', 'El-Hattab|Ahmed|A|', 'Rossi|Nicholas P|NP|']
D000293:Adolescent D000714:Anastomosis, Surgical D001013:Aorta, Thoracic D001017:Aortic Coarctation D001027:Aortography D006348:Cardiac Surgical Procedures D002648:Child D002675:Child, Preschool D000066491:Clinical Decision-Making D003250:Constriction D004452:Echocardiography D005260:Female D006439:Hemodynamics D006801:Humans D007223:Infant D007231:Infant, Newborn D007484:Iowa D008297:Male D061646:Operative Time D012008:Recurrence D012189:Retrospective Studies D012307:Risk Factors D013908:Thoracotomy D013997:Time Factors D016896:Treatment Outcome
bovine arch coarctation of the aorta congenital heart disease outcomes pediatric