Optimal surgical approach for repair of aortopulmonary window
C C Hew1, E A Bacha, D Zurakowski
1Department of Cardiovascular Surgery, The Children's Hospital, Harvard Medical School, Boston, Massachussets, USA.
Background:
This is a review of the experience over 26 year in a single institution with surgical repair of aortopulmonary window.
Methods:
Between July 1973 and March 1999, 38 patients underwent surgery for aortopulmonary window at a median age of 5 weeks, and with a median weight of 3.9 kg. Median follow-up was 6.6 years, with a range from 0.8 to 26 years. Additional defects were present in 25 (65%) patients, including interruption of the aortic arch in 7, tetralogy of Fallot in 7, ventricular septal defect in 5, functionally univentricular anatomy in 3, aortic coarctation in 2, and anomalous origin of a coronary artery in 1. We approached via an aortotomy in 45%, an incision through the defect in 31%, and using a pulmonary arteriotomy in 24% of patients. Closure was achieved using a single patch in 30 patients (79%).
Results:
There were 3 (7.9%) in-hospital deaths. Actuarial patient survival was 88% at 10 years. Three patients required reinterventions for stenoses of the great arteries. Freedom from any reintervention was 70% at 10 years. By multivariate analysis, the approach through a pulmonary arteriotomy was shown to result in a higher need for reintervention (p = 0.01).
Conclusions:
Repair of aortopulmonary window can be done with excellent results. A pulmonary arteriotomy should be avoided.
