Early results of direct repair of aortic interruption by the lateral approach.

Eleven consecutive patients were operated on for interruption of the aortic arch by direct aortoplasty through a lateral approach. Median age was 5 days and median weight, 3.52 kg. All received prostaglandin E. Four of the 11 required preoperative ventilatory and inotropic support. Diagnosis was by echocardiography with one confirmed by angiography. There were five type B and six type A interruptions. Aortic continuity was achieved through a left thoracotomy. The aorta and great vessels were mobilized, and after clamps were placed above and below the interruption, ductal tissue was excised and direct anastomosis performed. There was one death from sepsis. One patient died of pulmonary hypertension early after the second operation for correction of other anomalies, and 1 died of hypoplastic lungs after 6 months of ventilation. In 10 of the 11 patients there was no postoperative gradient. Palliative staged approach for correction of this malformation is advocated. The need for bypass and profound hypothermia is removed. This approach restores aortic continuity without sacrifice of the major vessels, use of ductal tissue, or use of prosthetic grafts that will necessitate reoperation.