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Native Tissue Aortic Arch Reconstruction Using Ascending Sliding Arch Aortoplasty: Early And Mid-term Outcomes
Thai Duy Nguyen, MD¹, Ali Dodge-Khatami, MD, PhD¹, Urda Gottschalk, MD², Mustafa Gülgün, MD¹, Majed Kanaan, MD¹, Ulrike Herberg, MD, PhD¹, André Rüffer, MD, PhD¹.
¹University Hospital Aachen, Aachen, Germany, ²University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Objective(s):
Challenging anatomy, growth potential and durability after patch-based aortic arch reconstruction in neonates and infants led us to seek an alternative technique based on optimization of autologous tissue utilization. We evaluated outcomes after ascending sliding arch aortoplasty for hypoplastic and interrupted aortic arch.
Methods:
From 2020 to 2025, 33 patients underwent primary or redo repair for hypoplastic or interrupted aortic arch using ascending sliding arch aortoplasty techniques. Median age was 110 days (range: 2-4442) and median weight 4.4 kg (range: 2.1-43 kg). Fourteen patients underwent redo sternotomy after previous arch repair or hybrid palliation. Reconstruction integrated distal interdigitation with proximal sliding of the ascending aorta using autologous tissue. Figure 1 demonstrates the sliding reconstruction technique for interrupted aortic arch.
Results:
There was one mortality 20 days postoperatively in a high-risk patient with borderline left heart structures and unbalanced atrioventricular septal defect after conversion to univentricular palliation. Early complications included ECMO support (n=2) and recurrent laryngeal nerve palsy (n=1). At a median follow-up of 46 months, recurrent arch obstruction occurred in two patients (6.1%), both successfully treated by patch enlargement of the ascending aorta.
Conclusions:
Ascending sliding arch aortoplasty offers an effective strategy for primary and secondary aortic arch reconstruction with encouraging early- and mid-term outcomes. Further investigation is necessary whether patch enlargement of a small ascending aorta during the initial repair can prevent recurrent obstruction.

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