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    
Abstract/OtherAbstract:
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.
Authors:
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.
Affiliation:
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
Descriptor/Qualifier:
Anastomosis, Surgical
Aorta, Thoracic / abnormalities,  surgery*
Aortic Diseases / congenital,  surgery*
Female
Heart Defects, Congenital / surgery
Humans
Infant
Infant, Newborn
Male
Time Factors
Treatment Outcome
Vascular Surgical Procedures / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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