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J Thorac Cardiovasc Surg 2010;139:942-949
© 2010 The American Association for Thoracic Surgery

Congenital Heart Disease

Twenty-three years of single-stage end-to-side anastomosis repair of interrupted aortic arches

^a Department of Cardiac Surgery, Royal Children's Hospital, The University of Melbourne Department of Paediatrics and the Murdoch Children's Research Institute, Melbourne, Australia
^b Department of Cardiology, Royal Children's Hospital, The University of Melbourne Department of Paediatrics and the Murdoch Children's Research Institute, Melbourne, Australia
^c Clinical Epidemiology and Biostatistical Unit, Royal Children's Hospital, The University of Melbourne Department of Paediatrics and the Murdoch Children's Research Institute, Melbourne, Australia
^d Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
^e Department of Cardiology, Women's and Children's Hospital, Adelaide, Australia
^f Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia

Received for publication May 1, 2009; revisions received August 16, 2009; accepted for publication September 6, 2009.

^_* Address for reprints: Yves d'Udekem, MD, PhD, Department of cardiac Surgery, Royal Children's Hospital, Flemington Rd, Parkville, Melbourne 3052, Victoria, Australia. (Email: yves.dudekem{at}rch.org.au).

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.

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