Long-Term Outcomes Following Aortopulmonary Window Surgery in Children: A 20 Year Analysis

Aortopulmonary window (APW) is a rare congenital cardiac malformation characterized by a communication between the great arteries. This left-to-right shunt leads to pulmonary hypertension and failure to thrive. The aim of this study is to analyze short and long-term outcomes following APW repair over a 20 year period. Patients with APW who underwent surgical repair between September 1998 and August 2020 were included in the analysis. The study data was retrospectively collected and analyzed. Primary outcomes were in-hospital mortality and long-term survival. A total of 16 patients underwent APW closure during the study period. Median age at surgery was 101 days (IQR 39-113), median weight was 4.2 kg (IQR 3.4-4.8). One patient (6.3%) died within the first 30 postoperative days. Fifteen patients underwent repair using the sandwich technique while one patient was treated with double ligation. In-hospital mortality was 6.3% (1/16 patients). One patient (6.3%) required re-exploration due to bleeding and postoperative support with extracorporeal life support. One patient (6.3%) had a residual shunt in echocardiography prior to discharge. During a median follow-up of 4 years (IQR 2 months-15 years) no late deaths or redo surgeries occurred. Aortopulmonary window repair in our cohort was associated with low in-hospital mortality and no late deaths or reoperations during follow-up. While the sandwich-patch technique was predominantly used, both techniques applied in this study resulted in acceptable early and late outcomes. Larger multicenter studies are needed to confirm these findings.