Background The optimal autologous patch material for neonatal and infant aortic arch reconstruction remains debated. We compared the short- and mid-term clinical and morphological outcomes of autologous pericardial patches (PP) vs. pulmonary artery patches (PAP). Methods This retrospective, two-center study included 143 patients (≤1 year) undergoing biventricular arch reconstruction for coarctation with arch hypoplasia or interrupted aortic arch (2010–2022). Patients received either PP ( n = 81) or PAP ( n = 62). We evaluated clinical outcomes, recoarctation-free survival, and computational arch morphology, including temporal diameter ratios and centerline curvature. Results Cardiopulmonary bypass and cross-clamp times were significantly longer with PAP ( P 0.001). However, early mortality (overall 4.2%; P = 0.698) and 10-year freedom from recoarctation (overall 88.4%; P = 0.958) were comparable between the PP and PAP cohorts. Over a 4.0-year median follow-up, an elevated pre-discharge systolic peak velocity 2.48 m/s served as a significant clinical indicator of recoarctation (HR, 7.373; P 0.001). Morphologically, while PAP produced a significantly larger initial proximal arch-to-ascending aorta diameter ratio ( P 0.001 ), temporal regression indicated similar mid-term growth trajectories for both patches. Computational centerline analysis showed no significant differences in overall postoperative arch geometry. Conclusions Autologous PP and PAP provide comparable clinical and morphological outcomes. Although PAP yields a larger initial arch diameter, longitudinal arch remodeling may be significantly influenced by the native aortic wall. Achieving optimal initial geometric relief is paramount over patch selection to prevent late recoarctation.
Jiang et al. (2026) studied this question.