One-stage repair of interrupted aortic arch in infants_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Furong , SHI Guocheng , LV Jingjing , LIU Wei , ZHENG Jinghao , ZHANG Haibo ,  CHEN Huiwen

Department of Thoracic Surgery, Shanghai Children's Medical Center, Shanghai, 200127, P.R.China;

Corresponding author：

CHEN Huiwen, Email: hwhwcdm@qq.com

Keywords：

Interrupted aortic arch; combined anomalies; one-stage repair

DOI：

10.7507/1007-4848.201612032

Video：

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Objective To evaluate the outcome of surgical repair of interrupted aortic arch (IAA) combined with anomalies. Methods We retrospectively analyzed the clinical data of 48 patients with IAA combined with anomalies undergoing one-stage biventricular repair in Shanghai Children's Medical Center from November 2006 to April 2016. There were 25 males and 23 females with a median age of 29 d (range, 8 to 91 d) and a mean weight of 3.80±0.67 kg. All patients underwent end-to-end anastomosis with patch augmentation, and relief of left ventricular outflow tract obstruction (LVOTO) was performed in 11 patients. Results In IAA children with anomalies, 39 (81.3%) suffered noncomplex lesions and 9 (18.8%) complex lesions. Mean follow-up was 72.1±19.7 months for 38 patients. There were 6 in-hospital deaths and 3 patients died during follow-up. The early survival rate was 87.5%, 5-year rate 83.3% and 10-year rate 81.3%. Reintervention was required in 10 patients, including 8 with subsequent LVOTO and 2 with anastomotic stenosis. Conclusion End-to-end anastomosis with patch augmentation is effective for IAA.

Citation： LIU Furong, SHI Guocheng, LV Jingjing, LIU Wei, ZHENG Jinghao, ZHANG Haibo, CHEN Huiwen. One-stage repair of interrupted aortic arch in infants. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(8): 589-593. doi: 10.7507/1007-4848.201612032 Copy

1.	Gordon EA, Person T, Kavarana M, et al. Interrupted aortic arch in the adult. J Cardiac Surg, 2011, 26(4): 405-409.
2.	李斌, 范太兵, 吴开元. 主动脉弓中断 28 例临床分析. 中华实用诊断与治疗杂志, 2014, 28(2): 173-174.
3.	Merrill DL, Webster CA, Samson PC. Congenital absence of the aortic isthmus; report of a case with successful surgical repair. J Thorac Surg, 1957, 33(3): 311-320.
4.	Todman SH, Eltayeb O, Ruzmetov M, et al. Outcomes of interrupted aortic arch repair using the carotid artery turndown procedure. J Thorac Cardiovasc Surg, 2013,145(1): 176-182.
5.	Flint JD, Gentles TL, MacCormick J, et al. Outcomes using predominantly single-stage approach to interrupted aortic arch and associated defects. Ann Thorac Surg, 2010, 89(2): 564-569.
6.	Hussein A, Iyengar AJ, Jones B, et al. Twenty-three years of single-stage end-to-side anastomosis repair of interrupted aortic arches. J Thorac Cardiovasc Surg, 2010, 139(4): 942-947, 949; discussion 948.
7.	Backer CL, Mavroudis C. Congenital Heart Surgery Nomenclature and Database Project: patent ductus arteriosus, coarctation of the aorta, interrupted aortic arch. Ann Thorac Surg, 2000, 69(4 Suppl): S298-S307.
8.	McCrindle BW, Tchervenkov CI, Konstantinov IE, et al. Risk factors associated with mortality and interventions in 472 neonates with interrupted aortic arch: a Congenital Heart Surgeons Society study. J Thorac Cardiovasc Surg, 2005,129(2): 343-350.
9.	Jegatheeswaran A, McCrindle BW, Blackstone EH, et al. Persistent risk of subsequent procedures and mortality in patients after interrupted aortic arch repair: a Congenital Heart Surgeons' Society study. J Thorac Cardiovasc Surg, 2010, 140(5): 1059-1075.
10.	Celoria GC, Patton RB. Congenital absence of the aortic arch. Am Heart J, 1959, 58: 407-413.
11.	Geva T, Hornberger LK, Sanders SP, et al. Echocardiographic predictors of left ventricular outflow tract obstruction after repair of interrupted aortic arch. J Am Coll Cardiol, 1993, 22(7): 1953-1960.
12.	Loffredo CA, Ferencz C, Wilson PD. Interrupted aortic arch: An epidemiologic study. Teratology, 2000, 61(5): 368-375.
13.	Roubertie F, Kalfa D, Vergnat M, et al. Aortopulmonary window and the interrupted aortic arch: midterm results with use of the single-patch technique. Ann Thorac Surg, 2015, 99(1): 186-191.
14.	Cetrano E, Polito A, Trezzi M, et al. Neonatal repair of persistent fifth aortic arch coarctation and interrupted fourth aortic arch. Ann Thorac Surg, 2017, 103(5): e475-e477.
15.	Kato N, Yamagishi M, Miyazaki T, et al. A novel surgical technique for right-sided interrupted aortic arch by interposition of a pulmonary autograft tube. Ann Thorac Surg, 2016, 102(2): e125-e127.
16.	Schreiber C, Eicken A, Vogt M, et al. Repair of interrupted aortic arch: results after more than 20 years. Ann Thorac Surg, 2000,70(6): 1896-1899.
17.	Morales DL, Scully PT, Braud BE, et al. Interrupted aortic arch repair: aortic arch advancement without a patch minimizes arch reinterventions. Ann Thorac Surg, 2006,82(5): 1577-1583.
18.	Lee MG, Brink J, Galati JC, et al. End-to-side repair for aortic arch lesions offers excellent chances to reach adulthood without reoperation. Ann Thorac Surg, 2014,98(4): 1405-1411.
19.	Mishra PK. Management strategies for interrupted aortic arch with associated anomalies. Eur J Cardiothorac Surg, 2009, 35(4): 569-576.
20.	Alsoufi B, Schlosser B, McCracken C, et al. Selective management strategy of interrupted aortic arch mitigates left ventricular outflow tract obstruction risk. J Thorac Cardiovasc Surg, 2016, 151(2): 412-420.
21.	Kaza AK, Thiagarajan RR. Left Ventricular outflow tract obstruction: coarctation of the aorta, interrupted aortic arch, and borderline left ventricle. Pediatr Crit Care Med, 2016, 17(8 Suppl 1): S315-S317.
22.	Salem MM, Starnes VA, Wells WJ, et al. Predictors of left ventricular outflow obstruction following single-stage repair of interrupted aortic arch and ventricular septal defect. Am J Cardiol, 2000, 86(9): 1044-1047.

1. Gordon EA, Person T, Kavarana M, et al. Interrupted aortic arch in the adult. J Cardiac Surg, 2011, 26(4): 405-409.
2. 李斌, 范太兵, 吴开元. 主动脉弓中断 28 例临床分析. 中华实用诊断与治疗杂志, 2014, 28(2): 173-174.
3. Merrill DL, Webster CA, Samson PC. Congenital absence of the aortic isthmus; report of a case with successful surgical repair. J Thorac Surg, 1957, 33(3): 311-320.
4. Todman SH, Eltayeb O, Ruzmetov M, et al. Outcomes of interrupted aortic arch repair using the carotid artery turndown procedure. J Thorac Cardiovasc Surg, 2013,145(1): 176-182.
5. Flint JD, Gentles TL, MacCormick J, et al. Outcomes using predominantly single-stage approach to interrupted aortic arch and associated defects. Ann Thorac Surg, 2010, 89(2): 564-569.
6. Hussein A, Iyengar AJ, Jones B, et al. Twenty-three years of single-stage end-to-side anastomosis repair of interrupted aortic arches. J Thorac Cardiovasc Surg, 2010, 139(4): 942-947, 949; discussion 948.
7. Backer CL, Mavroudis C. Congenital Heart Surgery Nomenclature and Database Project: patent ductus arteriosus, coarctation of the aorta, interrupted aortic arch. Ann Thorac Surg, 2000, 69(4 Suppl): S298-S307.
8. McCrindle BW, Tchervenkov CI, Konstantinov IE, et al. Risk factors associated with mortality and interventions in 472 neonates with interrupted aortic arch: a Congenital Heart Surgeons Society study. J Thorac Cardiovasc Surg, 2005,129(2): 343-350.
9. Jegatheeswaran A, McCrindle BW, Blackstone EH, et al. Persistent risk of subsequent procedures and mortality in patients after interrupted aortic arch repair: a Congenital Heart Surgeons' Society study. J Thorac Cardiovasc Surg, 2010, 140(5): 1059-1075.
10. Celoria GC, Patton RB. Congenital absence of the aortic arch. Am Heart J, 1959, 58: 407-413.
11. Geva T, Hornberger LK, Sanders SP, et al. Echocardiographic predictors of left ventricular outflow tract obstruction after repair of interrupted aortic arch. J Am Coll Cardiol, 1993, 22(7): 1953-1960.
12. Loffredo CA, Ferencz C, Wilson PD. Interrupted aortic arch: An epidemiologic study. Teratology, 2000, 61(5): 368-375.
13. Roubertie F, Kalfa D, Vergnat M, et al. Aortopulmonary window and the interrupted aortic arch: midterm results with use of the single-patch technique. Ann Thorac Surg, 2015, 99(1): 186-191.
14. Cetrano E, Polito A, Trezzi M, et al. Neonatal repair of persistent fifth aortic arch coarctation and interrupted fourth aortic arch. Ann Thorac Surg, 2017, 103(5): e475-e477.
15. Kato N, Yamagishi M, Miyazaki T, et al. A novel surgical technique for right-sided interrupted aortic arch by interposition of a pulmonary autograft tube. Ann Thorac Surg, 2016, 102(2): e125-e127.
16. Schreiber C, Eicken A, Vogt M, et al. Repair of interrupted aortic arch: results after more than 20 years. Ann Thorac Surg, 2000,70(6): 1896-1899.
17. Morales DL, Scully PT, Braud BE, et al. Interrupted aortic arch repair: aortic arch advancement without a patch minimizes arch reinterventions. Ann Thorac Surg, 2006,82(5): 1577-1583.
18. Lee MG, Brink J, Galati JC, et al. End-to-side repair for aortic arch lesions offers excellent chances to reach adulthood without reoperation. Ann Thorac Surg, 2014,98(4): 1405-1411.
19. Mishra PK. Management strategies for interrupted aortic arch with associated anomalies. Eur J Cardiothorac Surg, 2009, 35(4): 569-576.
20. Alsoufi B, Schlosser B, McCracken C, et al. Selective management strategy of interrupted aortic arch mitigates left ventricular outflow tract obstruction risk. J Thorac Cardiovasc Surg, 2016, 151(2): 412-420.
21. Kaza AK, Thiagarajan RR. Left Ventricular outflow tract obstruction: coarctation of the aorta, interrupted aortic arch, and borderline left ventricle. Pediatr Crit Care Med, 2016, 17(8 Suppl 1): S315-S317.
22. Salem MM, Starnes VA, Wells WJ, et al. Predictors of left ventricular outflow obstruction following single-stage repair of interrupted aortic arch and ventricular septal defect. Am J Cardiol, 2000, 86(9): 1044-1047.

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