OBJECTIVE: To assess outcomes of surgical repair of aortic arch obstructions with associated cardiac anomalies, we reviewed our institutional experience. METHODS: Between 1995 and 2005, 90 consecutive patients with interrupted aortic arch (n=25) or coarctation of the aorta (n=65) and cardiac anomalies underwent biventricular repair. Coexisting cardiac anomalies included ventricular septal defect (VSD, n=69), transposition of the great arteries (n=11), Taussig-Bing heart (n=4), double-outlet right ventricle with subaortic VSD (n=1), atrioventricular septal defect (n=4), and an aortopulmonary window (n=1). Arch reconstruction was accomplished by a subclavian flap aortoplasty in 12 patients, end-to-end anastomosis in 23, and end-to-side anastomosis in 55. RESULTS: The overall early and late mortalities were 5.6% (n=5) and 6.7% (n=6), respectively. The overall survival was 87%+/-3.7% at 10 years. Mortalities for VSD and for complex cardiac anomalies were 4.4% and 7.8%, respectively. Univariate analysis identified types of associated cardiac anomalies as a predictor for death, with the survival of patients with VSD significantly better than the other complex cardiac anomalies (p<0.05). There was a trend for single-stage repair to be associated with lower mortality compared with staged repair (p=0.06). No patients undergoing end-to-side arch reconstruction had a recurrent obstruction. CONCLUSIONS: The type of associated intracardiac anomalies with arch obstruction influenced postoperative outcomes. Although both approaches could achieve good results, our data suggest that single-stage repair for arch obstruction with VSD may be associated with better survival, and is therefore recommended.
OBJECTIVE: To assess outcomes of surgical repair of aortic arch obstructions with associated cardiac anomalies, we reviewed our institutional experience. METHODS: Between 1995 and 2005, 90 consecutive patients with interrupted aortic arch (n=25) or coarctation of the aorta (n=65) and cardiac anomalies underwent biventricular repair. Coexisting cardiac anomalies included ventricular septal defect (VSD, n=69), transposition of the great arteries (n=11), Taussig-Bing heart (n=4), double-outlet right ventricle with subaortic VSD (n=1), atrioventricular septal defect (n=4), and an aortopulmonary window (n=1). Arch reconstruction was accomplished by a subclavian flap aortoplasty in 12 patients, end-to-end anastomosis in 23, and end-to-side anastomosis in 55. RESULTS: The overall early and late mortalities were 5.6% (n=5) and 6.7% (n=6), respectively. The overall survival was 87%+/-3.7% at 10 years. Mortalities for VSD and for complex cardiac anomalies were 4.4% and 7.8%, respectively. Univariate analysis identified types of associated cardiac anomalies as a predictor for death, with the survival of patients with VSD significantly better than the other complex cardiac anomalies (p<0.05). There was a trend for single-stage repair to be associated with lower mortality compared with staged repair (p=0.06). No patients undergoing end-to-side arch reconstruction had a recurrent obstruction. CONCLUSIONS: The type of associated intracardiac anomalies with arch obstruction influenced postoperative outcomes. Although both approaches could achieve good results, our data suggest that single-stage repair for arch obstruction with VSD may be associated with better survival, and is therefore recommended.
Authors: Mark D Plunkett; Brian A Harvey; Lazaros K Kochilas; Jeremiah S Menk; James D St Louis Journal: Ann Thorac Surg Date: 2014-08-19 Impact factor: 4.330