The total repair of interrupted arch complex in infants: the anterior approach

Results of repair of the interrupted arch complex have remained poor despite advances in operative technique. Palliative prosthetic grafts to form a transverse arch through the lateral approach have been advocated, but a need for both subsequent closure of the ventricular septal defect and replacement of the prosthetic conduit makes this approach undesirable. The total experience with this lesion at the University of California San Francisco (29 patients) is presented. Since January 1982, 10 patients, eight with type B and two with type A interrupted arch, underwent total repair. Ages ranged from 3 to 150 days (median 11 days). An anterior approach to total repair with single atrial-to-ascending aortic and transductal descending aortic bypass was used. Deep hypothermia to less than 18 degrees C was used, and during total circulatory arrest the cannula was removed from the descending aorta and direct anastomosis of the descending and ascending aorta was performed. Total circulatory arrest time was a mean of 12 min. During rewarming of the infant, the ventricular septal defect was closed. Mean pump time was 52 min. Operative mortality was 20% (two of 10 patients) at 17 and 32 days after surgery. Our results demonstrate that the anterior approach to total repair of interrupted arch complex in early infancy can be achieved with a lower mortality than palliation followed by subsequent closure of ventricular septal defect and also obviates the need for prosthetic replacement of the transverse arch. The anterior approach is the method of choice for repair of interrupted arch complex.