Interrupted aortic arch repair: aortic arch advancement without a patch minimizes arch reinterventions

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease
• Thoracic Surgery

Background:

• Interrupted aortic arch (IAA) repair is challenging, with high mortality and reintervention rates.
• The Congenital Heart Surgeons' Society (CHSS) identified techniques other than direct anastomosis with patch augmentation as risk factors for reintervention.
• This study examines the aortic arch advancement technique without a patch for IAA repair at Texas Children's Hospital.

Purpose of the Study:

• To evaluate the effectiveness of aortic arch advancement without a patch in IAA repair.
• To identify risk factors for mortality and reintervention after IAA repair.
• To assess the impact of selective cerebral perfusion on outcomes.

Main Methods:

• A retrospective review of 60 patients undergoing IAA repair using aortic arch advancement without a patch (July 1995-December 2005).
• Selective cerebral perfusion was utilized in 42% of patients.
• Cox proportional hazards models analyzed 20 variables to determine risk factors for death and reintervention.

Main Results:

• Five-year freedom from aortic arch reintervention was 100%.
• Overall 5-year survival was 76% (94% since July 2000).
• Risk factors for death included older age, multiple congenital anomalies, DiGeorge syndrome, and bicuspid aortic valve; selective cerebral perfusion was protective.

Conclusions:

• Aortic arch advancement without a patch is a viable technique for IAA repair, minimizing the need for arch reintervention.
• This technique offers excellent survival rates, potentially enhanced by selective cerebral perfusion.
• Outcomes are favorable for IAA patients without complex associated cardiac anomalies.