Document Detail

Twenty-three years of single-stage end-to-side anastomosis repair of interrupted aortic arches.
MedLine Citation:
PMID:  20304139     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This study defined long-term results of a policy of single-stage repair of interrupted aortic arch with end-to-side anastomosis. METHODS: Records of 112 consecutive patients undergoing interrupted aortic arch repair between 1985 and 2007 were reviewed. Single-stage repair was performed in 95 patients, with 90 having end-to-side repair. RESULTS: There were 11 in-hospital deaths (10%). Twelve patients needed arch reintervention during the same hospital stay: 7 for residual arch obstruction and 5 for left main bronchus obstruction. Nine patients were unavailable for follow-up. After a mean of 10 +/- 7 years, 6 late deaths occurred, for 18-year survival of 92% (95% confidence interval [CI], 84%-97%). Patients with end-to-side anastomoses had better 18-year survival (97%, 95% CI, 87%-99%, vs 74%, 95% CI, 44%-89%, P < .01). After discharge, 19 patients underwent further aortic arch intervention. The only factors predictive of late arch reintervention were technique other than end-to-side (P < .001) and reoperation for left outflow tract obstruction. Freedom from arch reintervention after end-to-side repair was 78% at 18 years (95% CI, 59%-89%). Another 16 patients had significant residual obstruction. The 18-year freedom from hypertension was 88% (95% CI, 72%-95%). CONCLUSIONS: Single-stage repair with end-to-side anastomosis seems the best approach for most neonates with interrupted aortic arch, because it provides relief of the arch obstruction with low early mortality. After 2 decades of experience with this approach, incidence of late hypertension seems minimal. The need for further arch reintervention warrants close follow-up of these patients.
Aisyah Hussein; Ajay J Iyengar; Bryn Jones; Susan M Donath; Igor E Konstantinov; Leeanne E Grigg; Gavin Wheaton; Andrew Bullock; Christian P Brizard; Yves d'Udekem
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  139     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-22     Completed Date:  2010-05-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  942-7, 949; discussion 948     Citation Subset:  AIM; IM    
Copyright Information:
Crown Copyright 2010. Published by Mosby, Inc. All rights reserved.
Department of Cardiac Surgery, Royal Children's Hospital, The University of Melbourne Department of Paediatrics and the Murdoch Children's Research Institute, Melbourne, Australia.
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MeSH Terms
Anastomosis, Surgical
Aorta, Thoracic / abnormalities,  surgery*
Aortic Diseases / congenital,  surgery*
Heart Defects, Congenital / surgery
Infant, Newborn
Time Factors
Treatment Outcome
Vascular Surgical Procedures / methods*

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