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J Thorac Cardiovasc Surg 2006;131:1136-1141
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Surgical management of aortopulmonary window associated with interrupted aortic arch: A Congenital Heart Surgeons Society study

^a Hospital for Sick Children, Toronto, Canada
^b Children's Hospital of New York, New York
^c Children's Hospital of Boston, Boston, Mass
^d Children's Hospital of Philadelphia, Philadelphia, Pa
^e Cleveland Clinic, Cleveland, Ohio

Received for publication January 8, 2005; revisions received February 28, 2005; accepted for publication March 23, 2005.

^_* Address for reprints: Brian W. McCrindle, MD, The Hospital for Sick Children 555 University Avenue, Toronto, Ontario, Canada M5G 1X8 (Email: brian.mccrindle{at}sickkids.ca).

OBJECTIVE: The objective was to determine outcomes and risk factors of surgical management of patients with aortopulmonary window associated with interrupted aortic arch.

METHODS: From 1987 to 1997, 472 neonates with interrupted aortic arch were enrolled prospectively from 33 institutions. Associated aortopulmonary window was present in 20 patients. Competing risk methodology determined the prevalence of reintervention for postrepair pulmonary artery and aortic arch obstruction.

RESULTS: Interrupted aortic arch was type A in 17 patients and type B in 3 patients. Aortopulmonary window morphology was type I (n = 10), type II (n = 5), and type III (n = 5). Associated cardiovascular anomalies were common, including atrial septal defect (n = 13) and systemic venous anomalies (n = 3). Overall survival after initial admission was 91%, 86%, and 84% at 1, 5, and 10 years, respectively. Fifteen patients underwent single-stage repair, and 4 patients underwent staged repair. There was an increased prevalence of patch augmentation of the interrupted aortic arch anastomosis in lower-weight infants (2.3 kg vs 3.1 kg, P = .07). Competing risk analysis estimated that 5 years after repair, 51% had initial arch reintervention, 6% had initial pulmonary artery reintervention, and 43% were alive without reintervention. Reintervention for arch obstruction was more likely for those with interrupted aortic arch type B (P = .08) and for those with higher weight at initial repair (P = .003).

CONCLUSIONS: Complete correction of aortopulmonary window in the setting of interrupted aortic arch can be performed with low mortality in the neonatal period. Reinterventions for aortic arch obstruction are the most frequent complication after repair, but pulmonary artery stenosis also occurs. Use of patch augmentation may reduce the need for subsequent arch reintervention.

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