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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 688-695, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
TR Karl, S Sano, W Brawn and RB Mee
Herein we describe our experience with repair of interrupted aortic arch
and coarctation plus hypoplastic aortic arch in 55 consecutive infants
(1984 to 1990). Median age at operation was 6 days and median weight 3.1
kg. Associated severe intracardiac anomalies were the rule. All patients
had significant congestive cardiac failure, and the majority required
prostaglandin E1 resuscitation and inotropic support (with or without
ventilation) before the operation. All operations were performed via
sternotomy with core cooling and circulatory arrest. Isolated myocardial
perfusion was used in 13 patients during arch repair. A complete
intracardiac (biventricular) repair was performed except in patients
expected to require a Fontan operation as definitive treatment. The
operative mortality overall was 14.5% (confidence limits 10% to 22%). For
arch repair plus biventricular intracardiac repair, the operative mortality
was 9% (confidence limits 5% to 15%), and for arch repair plus palliative
intracardiac repair, 40% (confidence limits 22% to 60%). The mortality in
the isolated myocardial perfusion group was 0% (confidence limits 0% to
14%), which may be related to reduced myocardial ischemic time (p less than
0.05). Actuarial survival was 75% (confidence limits 65% to 83%) at 12
months, with no subsequent deaths over 1294 patient-months (mean 28 months)
of follow-up. Actuarial freedom from recurrent arch obstruction was 69%
(confidence limits 48% to 85%) at 46 months' follow-up. Primary repair of
interrupted aortic arch and coarctation plus hypoplastic arch compares
favorably with a staged approach and is recommended even when complex
intracardiac anatomy is present.
ARTICLES
Repair of hypoplastic or interrupted aortic arch via sternotomy
Victorian Paediatriac Cardiac Surgical Unit, Royal Children's Hospital, Melbourne, Australia.
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