Outcomes Using Predominantly Single-Stage Approach to Interrupted Aortic Arch and Associated Defects (original) (raw)
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Staged Biventricular Repair After Hybrid Procedure in High-Risk Neonates and Infants
World Journal for Pediatric and Congenital Heart Surgery, 2019
Background: Single-stage biventricular repair remains a challenging and difficult decision in high-risk newborns and early infants with the presence of left ventricular outflow tract obstruction (LVOTO) or borderline hypoplasia of the left ventricle (LV). Methods: Six high-risk patients underwent the initial hybrid procedure (bilateral pulmonary banding + ductal stenting) for staged biventricular repair. Their median age was 17 days (range: 7-55 days). The diagnosis was interrupted aortic arch (IAA), ventricular septal defect (VSD), and LVOTO (n = 3); IAA and VSD (n = 1); and aortic annular hypoplasia, aortic arch hypoplasia, VSD, and LVOTO (n = 1). The last patient had borderline LV with large atrial septal defect (ASD) and aortic arch hypoplasia. The patient with borderline LV had also ASD closure with small fenestration. Results: One patient died of sepsis after the hybrid procedure. Other patients underwent biventricular repair 8 to 13 months later. Three patients had convention...
Staged repair of interrupted aortic arch and ventricular septal defect in infancy☆
The Annals of Thoracic Surgery, 1991
Staged repair of interrupted aortic arch and ventricular septal defect was carried out in 20 infants from 1979 through 1990. Among the important associated cardiac defects were transposition of the great arteries, truncus arteriosus, and anomalous origin of the right pulmonary artery. The first stage, usually consisting of the placement of an 8-or 10-mm polytetrafluoroethylene graft, pulmonary artery banding, and ligation of the patent ductus arteriosus, resulted in 20 survivors (100%) There were two interim deaths (10%) before the second stage of ventricular septal defect closure and pulmonary artery band removal, which had 15 survivors (83%, 15/18). Because the major morbidity and mortality early in this experience could be traced to leaving the pulmonary artery band on too long, early removal (within 2 to 3 months) was begun. Since 1985, 8 (100%) of 8 infants he outlook has greatly improved for infants born with T interrupted aortic arch (IAA), ventricular septal defect (VSD), and patent ductus arteriosus (PDA), which, until relatively recently, was usually lethal [l]. Several series [2-9; Bowman FO Jr, unpublished results] have reported survival of more than 50% of infants after operation either by a staged approach or by primary repair, and the trend is to further improvement. Complete repair in which the PDA is excised, a primary aortic anastomosis is carried out, and the VSD is closed has considerable appeal, and successful series have been reported from several institutions [ 5 7 , Bowman FO Jr, unpublished results]. On the other hand, excellent results have been reported using a staged procedure in which the arch is repaired first, usually with a conduit, and the pulmonary artery (PA) banded. Later, the VSD is closed and the PA band removed [ 2 4 , 81. Infants with an IAA may have a constellation of problems, and longer follow-up and evaluation will be necessary to accurately determine the advantages and disadvantages of each approach. Despite the attraction and apparent increasing success rate of primary repair, there may be a subset of infants for whom the staged approach would be the best choice. Moreover, our midterm results continue to suggest there may be advantages to this approach for the entire group. The purpose of this report Presented in part at the Current Controversies and Techniques in Congenital Heart Surgery Meeting, Baltimore, MD, Sep &9, 1989. Address reprint requests to Dr Foker, Box 495 UMHC, 420 Delaware St SE, Minneapolis, MN 55455.
The Journal of Thoracic and Cardiovascular Surgery, 2005
We sought to determine the prevalence of outcomes and associated patient and management factors for neonates with interrupted aortic arch. Methods: From 1987 to 1997, a total of 472 neonates were enrolled prospectively from 33 institutions. Competing risks methodology was used to determine simultaneous risk and associated incremental risk factors for death, initial and subsequent left ventricular outflow tract procedures, and arch reinterventions. Results: Overall survival was 59% at 16 years after study entry but improved with successive birth cohort. In general, risk factors for death in each of the competing risks analyses included lower birth weight, younger age at study entry, type B interrupted aortic arch, and major associated cardiac anomalies. Of 453 patients who had interrupted aortic arch repair, after 16 years 33% had died and 28% had undergone an arch reintervention. Reintervention was more likely for those who had truncus arteriosus repair, interrupted aortic arch repair by a method other than direct anastomosis with patch augmentation, and the use of polytetrafluoroethylene as either an interposition graft or a patch. From study entry, competing risks after 16 years showed that 28% had died and 34% had undergone an initial left ventricular outflow tract procedure. Initial left ventricular outflow tract procedure was more likely for those with single ventricle, type B interrupted aortic arch, bicuspid aortic valve, or anomalous right subclavian artery. Among those who had undergone an initial left ventricular outflow tract procedure, after 16 years 37% had died and 28% had undergone a second procedure. Conclusion: Anatomic features affect mortality and initial left ventricular outflow tract procedures, whereas characteristics of the arch repair affect arch reintervention. I nterrupted aortic arch (IAA) occurs infrequently, and although most patients have only an isolated ventricular septal defect (VSD), more complex associated cardiovascular anomalies may occur. In addition, a spectrum of left ventricular outflow tract (LVOT) obstructive lesions, particularly subaortic stenosis, may further complicate management. Although recent reports have reflected improvements in operative survival, further interventions are often required to address residual or recurrent left heart outflow or arch repair obstructions. A previous Congenital Heart Surgeons Society (CHSS) study reported outcomes for 183 neonates entered from 1987 to 1992.
Neonatal Cardiac Surgery in the New Era: Lessons learned from 1000 Consecutive Cases
The Israel Medical Association journal : IMAJ, 2016
neonatal cardiac surgery has evolved over the last 50 years with a large percentage of the patients achieving complete physiological repair in the neonatal period. The remaining patients achieve staged palliation with an increasing amount of success. To report our experience with 1000 neonatal cardiac surgical procedures performed in the last 10 years. We conducted a retrospective analysis of surgical outcome in all neonatal patients who underwent cardiac surgery between January 2007 and July 2016 at Schneider Children's Medical Center of Israel. A total of 1003 neonates aged < 30 days underwent surgery for congenital heart defects at our center. Neonatal surgery accounted for 22.5% of all cardiac surgeries. Neonatal operative mortality was 7.3%, Operative mortality for individual lesions were: simple aortic coarctation (CoA) (198 patients, 2.5%), CoA with hypoplastic arch (24, 4%), CoA with ventricular septal defect (VSD) (84, 2.3%), transposition of the great arteries (TGA,...
Current outcomes and future trends in paediatric and congenital cardiac surgery: a narrative review
Pediatric Medicine
Objective: To provide a narrative review of the current outcomes and future trends in paediatric and congenital cardiac surgery in a historical and multidisciplinary context. To present the paradigm shift in treating congenital heart disease that translate into improved outcomes. To identify current problems with directions of research. Background: Congenital heart disease (CHD) is the most common birth defect affecting approximately 1 neonate in every 120-166 births. More than half of CHD-patients need cardiac surgery in their lifetime; and half of the surgeries are required within the first six months of life. Methods: Narrative overview of the literature combining with current outcome data available from international databases is presented in comparison to the programme development of a newly-established tertiary-care centre. Conclusion: Congenital cardiac surgery is reconstructive surgery that aims for restoring biventricular circulation, when possible. Single-stage primary complete repair has become the central philosophy since the 1980s. In about thirty percent, physiologic and anatomical reasons do not permit repair by a single operation; these patients endure staged-repairs. Another 15% of CHD patients will require subsequent reoperationsmostly re-replacements of non-growing and/or deranged prostheses. Owing to advances of multidisciplinary treatment, CHD survival to adulthood now reaches 90-95% in high-income countries from less than 20% in the presurgical era. Treating CHD patients is a commitment for life. Research for viable and growing prostheses may solve the significant public health aspects currently associated with reoperations.
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2004
European Journal of Cardio-Thoracic Surgery, 2009
A newborn presented with severe aortic valve stenosis and a borderline hypoplastic left ventricle due to disproportionate left ventricular hypertrophy (maternal diabetes). The aortic valve was balloon dilated and the infant tolerated a biventricular circulation. However, severe retrograde pulmonary hypertension and mitral regurgitation developed, indicating that biventricular circulation was not possible at that stage. A hybrid approach with ductal stenting, atrial septostomy and bilateral dilatable pulmonary artery band placement was followed on day 25. This allowed the left ventricle several months to adapt to lower pressure and normoglycemic conditions. At re-evaluation after 8 months biventricular repair appeared possible: the ductus was closed with Amplatzer occluders and the pulmonary artery bands were opened up with bilateral balloon angioplasty of the dilatable bands. At the age of 3 years, the infant is doing well with a biventricular circulation and normal pulmonary artery pressure. The hybrid approach allowed adequate time (months) for careful consideration and acted as a bridge to biventricular repair in this infant. #