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Early results of direct repair of aortic interruption by the lateral approach
1Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, England.
Insights
Direct aortoplasty offers a novel surgical approach for aortic arch interruption, avoiding bypass and hypothermia. This technique successfully restored aortic continuity in most patients, improving outcomes for this critical congenital heart defect.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Defects
Background:
- Interruption of the aortic arch is a severe congenital heart defect requiring timely surgical intervention.
- Traditional surgical methods often involve cardiopulmonary bypass and hypothermia, carrying significant risks.
- Minimally invasive techniques are sought to improve outcomes and reduce complications.
Purpose of the Study:
- To evaluate the efficacy and safety of direct aortoplasty via a lateral approach for aortic arch interruption.
- To assess the feasibility of this technique in neonates and infants.
- To determine if this method can avoid the need for cardiopulmonary bypass and profound hypothermia.
Main Methods:
- A consecutive series of eleven patients with aortic arch interruption underwent direct aortoplasty through a left thoracotomy.
- Diagnosis was confirmed by echocardiography and/or angiography.
- Surgical technique involved mobilization of the aorta and great vessels, excision of ductal tissue, and direct anastomosis.
Main Results:
- Eleven patients (median age 5 days) were treated; five with Type B and six with Type A interruption.
- Ten out of eleven patients had no postoperative aortic gradient.
- Mortality was 27% (3/11), with causes including sepsis, pulmonary hypertension, and hypoplastic lungs.
Conclusions:
- Direct aortoplasty through a lateral approach is a viable alternative for aortic arch interruption, potentially avoiding bypass and hypothermia.
- This technique restores aortic continuity without sacrificing major vessels or requiring prosthetic grafts.
- A palliative staged approach is advocated, highlighting the benefits of this direct surgical method.
Abstract:
Eleven consecutive patients were operated on for interruption of the aortic arch by direct aortoplasty through a lateral approach. Median age was 5 days and median weight, 3.52 kg. All received prostaglandin E. Four of the 11 required preoperative ventilatory and inotropic support. Diagnosis was by echocardiography with one confirmed by angiography. There were five type B and six type A interruptions. Aortic continuity was achieved through a left thoracotomy. The aorta and great vessels were mobilized, and after clamps were placed above and below the interruption, ductal tissue was excised and direct anastomosis performed. There was one death from sepsis. One patient died of pulmonary hypertension early after the second operation for correction of other anomalies, and 1 died of hypoplastic lungs after 6 months of ventilation. In 10 of the 11 patients there was no postoperative gradient. Palliative staged approach for correction of this malformation is advocated. The need for bypass and profound hypothermia is removed. This approach restores aortic continuity without sacrifice of the major vessels, use of ductal tissue, or use of prosthetic grafts that will necessitate reoperation.