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Primary complete repair of interrupted aortic arch with associated lesions in infants
Guocheng Shi1, Huiwen Chen, Zheng Jinghao
1Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Heart Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Insights
Surgical repair of interrupted aortic arch (IAA) in infants using a single-stage approach with patch augmentation demonstrates effective outcomes. This method offers a viable treatment strategy for this complex congenital heart defect.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Neonatal Medicine
Background:
- Interrupted aortic arch (IAA) is a severe congenital heart defect requiring complex surgical management.
- Individualized strategies are crucial for successful surgical repair of IAA and associated anomalies.
Purpose of the Study:
- To report the surgical outcomes of one-stage biventricular repair for IAA with associated lesions in infants.
- To identify risk factors associated with mortality after IAA repair.
Main Methods:
- Retrospective review of 119 infants undergoing one-stage biventricular repair of IAA between 2000 and 2013.
- Utilized end-to-side anastomosis with patch augmentation in all cases.
- Selective cerebral perfusion was employed in 46% of patients; 23 patients required a left ventricular outflow tract obstruction procedure.
Main Results:
- The study included 92 cases of IAA type A and 27 of type B, with various associated anomalies.
- Overall actuarial survival was 84% at 30 days, decreasing to 79% at 10-13 years.
- Risk factors for mortality included complex lesions, critical aortic valve stenosis, and prolonged cardiopulmonary bypass duration.
Conclusions:
- Single-stage repair with end-to-side anastomosis and patch augmentation is an effective surgical approach for infants with IAA.
- This technique provides a reliable option for managing this complex congenital heart disease.
Objective:
Interrupted aortic arch (IAA) is a complicated congenital heart disease requiring an individualized management strategy. We reported the results for surgical repair of IAA with associated anomalies.
Methods:
This was a retrospective review of 119 patients undergoing one-stage biventricular repair of IAA with associated lesions at the median age of 18 days (range, 3 to 90) between 2000 and 2013. End-to-side anastomosis with patch augmentation was adopted in all patients. Left ventricular outflow tract obstruction (LVOTO) procedure was performed in 23 patients. Selective cerebral perfusion was used in 55 patients (46%).
Results:
IAA types were A in 92 patients (77%) and B in 27 (23%). Associated anomalies were multiple including noncomplex lesions in 91 (76%) and complex lesions in 28 (24%). Mean follow-up was 98.7 ± 74.2 months. Follow-up was 80% completed. There were 19 in-hospital and six late deaths. The overall actuarial survival including early mortality was 84% at 30 day, 81% at five years, and 79% at 10 and 13 years. Cox proportional hazard model was used to determine risk factors for death: presence of complex lesions (p = 0.005), critical aortic valve stenosis (AVS) (p = 0.016), and long cardiopulmonary bypass (CPB) duration (p = 0.036). Eighteen patients required re-intervention, including 16 for subsequent LVOTO and two for arch restenosis.
Conclusions:
Single-stage repair using end-to-side anastomosis with patch augmentation is an effective approach for infants with IAA.
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