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Outcomes following surgical repair of aortic arch obstructions with associated cardiac anomalies

The Department of Pediatric Cardiac Surgery, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan

Received 31 January 2008; received in revised form 15 August 2008; accepted 1 September 2008.

^_* Corresponding author. Tel.: +81 42 314 3111; fax: +81 42 314 9218. (Email: maando{at}shi.heart.or.jp).

Objective: To assess outcomes of surgical repair of aortic arch obstructions with associated cardiac anomalies, we reviewed our institutional experience. Methods: Between 1995 and 2005, 90 consecutive patients with interrupted aortic arch (n = 25) or coarctation of the aorta (n = 65) and cardiac anomalies underwent biventricular repair. Coexisting cardiac anomalies included ventricular septal defect (VSD, n = 69), transposition of the great arteries (n = 11), Taussig–Bing heart (n = 4), double-outlet right ventricle with subaortic VSD (n = 1), atrioventricular septal defect (n = 4), and an aortopulmonary window (n = 1). Arch reconstruction was accomplished by a subclavian flap aortoplasty in 12 patients, end-to-end anastomosis in 23, and end-to-side anastomosis in 55. Results: The overall early and late mortalities were 5.6% (n = 5) and 6.7% (n = 6), respectively. The overall survival was 87% ± 3.7% at 10 years. Mortalities for VSD and for complex cardiac anomalies were 4.4% and 7.8%, respectively. Univariate analysis identified types of associated cardiac anomalies as a predictor for death, with the survival of patients with VSD significantly better than the other complex cardiac anomalies (p < 0.05). There was a trend for single-stage repair to be associated with lower mortality compared with staged repair (p = 0.06). No patients undergoing end-to-side arch reconstruction had a recurrent obstruction. Conclusions: The type of associated intracardiac anomalies with arch obstruction influenced postoperative outcomes. Although both approaches could achieve good results, our data suggest that single-stage repair for arch obstruction with VSD may be associated with better survival, and is therefore recommended.

Key Words: Interrupted aortic arch • Coarctation of the aorta • Associated cardiac anomaly • Survival analysis