Long-term outcomes in children undergoing vascular ring division: a multi-institution experience

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Thoracic Surgery

Background:

• Vascular rings are rare congenital heart anomalies causing significant respiratory and gastrointestinal distress in infants and children.
• Surgical intervention is the primary treatment for symptomatic vascular rings.

Purpose of the Study:

• To evaluate the long-term outcomes of patients who underwent surgical division for vascular rings.
• To identify predictors of reoperation and residual symptoms following vascular ring division.

Main Methods:

• A multi-institution retrospective review of 371 patients with various types of vascular rings.
• Surgical division was performed between November 2007 and October 2019.
• Long-term follow-up data, including survival, reoperation rates, and symptom resolution, were analyzed.

Main Results:

• The 10-year overall survival rate was 96.8%, with a late mortality of 0.3%.
• The 10-year freedom from reoperation rate was 95.9%, with 5.6% of patients experiencing residual symptoms.
• Common vascular ring types included right aortic arch with left ligamentum arteriosum (36.7%) and pulmonary artery sling (22.9%).

Conclusions:

• Vascular ring division yields excellent long-term results with high survival and low reoperation rates.
• A Kommerell diverticulum exceeding 1.5 times the aberrant left subclavian artery origin is an indication for primary resection.
• Tracheomalacia is a significant risk factor for reoperation and persistent symptoms, underscoring the importance of preoperative fibrobronchoscopy.