Ascending aortic slide for interrupted aortic arch repair

In a recent editorial (1), Dr. Takeuchi summarized our report (2) on five neonates and infants undergoing repair of interrupted aortic arch (IAA) using the so-called “ascending aortic slide” technique. It was initially performed by Dr. William I. Norwood, without him ever publishing it, and was adopted by our team through description by memory after direct observation by one of our co-authors/colleagues who worked with Dr. Norwood in the 1980’s. In difficult situations, where the gap between the proximal and distal portions of the interrupted arch is too far apart to achieve a tension-free anastomosis, the reconstruction involves splitting the ascending aorta in half up to the take-off of the innominate artery, posteriorly rotating the free flap of native tissue towards the ipsilateral shoulder respective to arch-sidedness, with anastomosis to the distal portion of the arch. The opening in the filleted arch is reconstructed with a patch as per any arch repair, and may be used for biventricular or univentricular physiology. Other techniques in a similar situation, namely the subclavian flap, the reverse subclavian flap, an interposition graft, or incorporating the aortic branches in the anastomosis (3), all have potential drawbacks. The ascending aortic slide technique has potential advantages, including the use of a native tissue-to-tissue anastomosis with the potential to grow, providing a good posterior scaffold to facilitate anterior patch reconstruction, no tethering or compression of the airway, and no sacrifice of a major vessel.