Demetrios N Mallios1, W Hampton Gray1, Andrew L Cheng2, Winfield J Wells1, Vaughn A Starnes1, S Ram Kumar3. 1. Division of Cardiothoracic Surgery, Department of Surgery; Heart Institute, Children's Hospital, Los Angeles, Los Angeles, California, USA. 2. Division of Cardiology; Department of Pediatrics; Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Heart Institute, Children's Hospital, Los Angeles, Los Angeles, California, USA. 3. Division of Cardiothoracic Surgery, Department of Surgery; Department of Pediatrics; Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Heart Institute, Children's Hospital, Los Angeles, Los Angeles, California, USA. Electronic address: rsubramanyan@chla.usc.edu.
Abstract
BACKGROUND: In patients with interrupted aortic arch and ventricular septal defect (IAA/VSD) with small LVOT, either aortopulmonary amalgamation or Ross-Konno type procedure can be performed to create stable systemic outflow. We sought to analyze factors associated with these different surgical approaches. METHODS: We retrospectively identified patients who underwent surgical repair for IAA/VSD at our institution between 1998 and 2017. Of these, 43 patients had small, native LVOT that was unsuitable for systemic outflow. Patient data were retrospectively collected for this cohort and analyzed using SAS 9.4. RESULTS: Aortopulmonary amalgamation was performed at 7 (5-10) days in 30 patients (Group I). Within Group I, a primary Yasui repair with ventricular septation was performed in 3 patients, and a Norwood-type repair was performed in the other 27. Of these 27, 19 underwent subsequent biventricular conversion at 9 (7-11) months. In contrast, 13 patients (Group II) underwent Ross at 12 (6-27) days. Compared to Group I, Group II patients had a smaller VSD (3.5 vs. 5.1mm, p<0.001) that was more often remote from the semilunar valves (38% vs. 13%, p=0.02). Operative mortality occurred in 1 (4%) Group I patient at the time of biventricular conversion, and 2 (15%) Group II patients during Ross. After 5.2 (3.2-7.4)-year-follow-up, there have been two additional mortalities in each group, all unrelated to cardiac disease. CONCLUSIONS: When native LVOT in IAA/VSD is unsuitable for systemic outflow, size and location of the VSD can be used to tailor surgical approach to establish biventricular circulation with favorable intermediate term outcomes.
BACKGROUND: In patients with interrupted aortic arch and ventricular septal defect (IAA/VSD) with small LVOT, either aortopulmonary amalgamation or Ross-Konno type procedure can be performed to create stable systemic outflow. We sought to analyze factors associated with these different surgical approaches. METHODS: We retrospectively identified patients who underwent surgical repair for IAA/VSD at our institution between 1998 and 2017. Of these, 43 patients had small, native LVOT that was unsuitable for systemic outflow. Patient data were retrospectively collected for this cohort and analyzed using SAS 9.4. RESULTS: Aortopulmonary amalgamation was performed at 7 (5-10) days in 30 patients (Group I). Within Group I, a primary Yasui repair with ventricular septation was performed in 3 patients, and a Norwood-type repair was performed in the other 27. Of these 27, 19 underwent subsequent biventricular conversion at 9 (7-11) months. In contrast, 13 patients (Group II) underwent Ross at 12 (6-27) days. Compared to Group I, Group II patients had a smaller VSD (3.5 vs. 5.1mm, p<0.001) that was more often remote from the semilunar valves (38% vs. 13%, p=0.02). Operative mortality occurred in 1 (4%) Group I patient at the time of biventricular conversion, and 2 (15%) Group II patients during Ross. After 5.2 (3.2-7.4)-year-follow-up, there have been two additional mortalities in each group, all unrelated to cardiac disease. CONCLUSIONS: When native LVOT in IAA/VSD is unsuitable for systemic outflow, size and location of the VSD can be used to tailor surgical approach to establish biventricular circulation with favorable intermediate term outcomes.