Yasui Procedure with Aberrant Right Subclavian Artery Patch for Interrupted Aortic Arch (Type B)

Abstract

Reconstructing an interrupted aortic arch requiring a Damus–Kaye–Stansel (DKS) anastomosis can result in “gothic arch” formation due to extensive aortic mobilization, which is linked to late hypertension and bronchial compression. This repair is further complicated in the presence of an anomalous aberrant right subclavian artery (RSCA). We describe the use of a free aberrant RSCA patch (rather than a pedicled flap) to reconstruct the posterior aortic arch wall in 2 infants, both undergoing a staged Yasui procedure for interrupted aortic arch (type B) with hypoplastic left ventricular outflow tract. The harvested aberrant RSCA was opened longitudinally and fashioned into a patch to bridge the posterior aortic gap, with anterior reconstruction completed using a pulmonary homograft patch. Postoperative computed tomography scans confirmed smooth, rounded arch anatomy without a gothic appearance or signs of compression. This free patch modification provided greater surgical flexibility compared with previously described pedicled flap techniques while achieving excellent midterm anatomical outcomes optimized for subsequent DKS anastomosis and potential for growth.