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Posttransplant recoarctation of the aorta: a twelve year experience

Girish S. Shirali, MD, FACC^a, Constance E. Cephus, RN, MSN, NNP, Micheal A. Kuhn, MD, FACC^a, Kay K. Ogata, RN, MS, Laura K. Vander Dussen, RN, BS, Richard E. Chinnock, MD^a, Neda F. Mulla, MD, FACC^a, Joyce K. Johnston, RN, BS, Leonard L. Bailey, MD, FACC, Steven R. Gundry, MD, FACC, Anees J. Razzouk, MD, FACC and Ranae L. Larsen, MD, FACC^a

^a Department of Pediatrics, Loma Linda University Children’s Hospital, Loma Linda, California, USA
Department of Nursing, Loma Linda University Children’s Hospital, Loma Linda, California, USA
Department of Surgery, Loma Linda University Children’s Hospital, Loma Linda, California, USA

View larger version (98K): [in a new window]   Figure 1 Schematic diagram of extended aortic arch reconstruction as part of cardiac transplantation for aortic arch hypoplasia. Left panel, severe aortic arch hypoplasia extends up to the level of the insertion of the ductus arteriosus into the descending thoracic aorta. Cardiopulmonary bypass cannulas are in place and snares have been placed around the proximal ends of the aortic arch branches. Right panel, the donor atria are anastomosed to the posterior collar of recipient atria. An extended length of donor aorta is used to reconstruct the aortic arch; anastomotic suture lines are seen on the undersurface of the arch, extending beyond the level of the ductus arteriosus.

View larger version (10K): [in a new window]   Figure 2 Kaplan-Meier curve showing freedom from intervention for recoarctation after cardiac transplantation with extended reconstruction of the aortic arch. Values are shown as mean ± 95% confidence limits (1.96·SEM). Numbers above the x-axis represent the number of uncensored patients at each time point.

View larger version (10K): [in a new window]   Figure 3 Kaplan-Meier curve showing freedom from reintervention for recoarctation after balloon angioplasty/surgical repair of posttransplant recoarctation. Values are shown as mean ± 95% confidence limits (1.96·SEM). Numbers above the x-axis represent the number of uncensored patients at each time point.