Boston - American Association for Thoracic Surgery

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89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS51. Twenty Three Years of One-stage End-to-Side Anastomosis Repairof Interrupted Aortic ArchesYves d’Udekem, 1 Aisyah S. Hussin, 1 Ajay J. Iyengar, 1 Igor E. Konstantinov, 1Suzan M. Donath, 1 Gavin R. Wheaton, 2 Andrew M. Bullock, 3 Leeanne E. Grigg, 4Bryn O. Jones, 1 Christian P. Brizard 11. Cardiac Surgery, Royal Children’s Hospital, Parkville, Melbourne, VIC, Australia;2. Women’s and Children’s Hospital, Adelaide, SA, Australia; 3. Princess MargaretHospital, Perth, WA, Australia; 4. Royal Melbourne Hospital, Melbourne,VIC, AustraliaInvited Discussant: V. Mohan ReddyOBJECTIVE: To define the long-term results of a policy of one-stage repair ofinterrupted aortic arches with end-to-side (ETS) anastomosis.METHODS: Records of all pts undergoing interrupted aortic arch repair after theintroduction of the ETS technique were reviewed. From 1985 to 2007, 113 pts (60 males)were operated at a median of 6 days (1 d–2 y). Interruption was type A in 37 pts(33%), type B in 73 (64%), and type C in 3 (3%). Associated conditions were VSD(86), truncus (13), DORV (8), AP window (4), single ventricle (13). Subaortic stenosiswas suspected in 36 pts (31%). Fifty-five pts (49%) required ventilation and 33(30%) inotropic support prior surgery. One-stage repair was performed in 100 pts(89%), 93 having ETS repair. Before 2000, one-stage repair was performed underdeep hypothermic circulatory arrest, and thereafter with moderate hypothermiaand selective cerebral perfusion.RESULTS: There were 12 hospital deaths (11%). The only predictive factor of hospitalmortality was repair different than ETS (25% (5/20) vs 8% (7/93); p < 0.05).Twelve pts needed arch reintervention during the same hospital stay: 8 for residualarch obstruction (5 ETS), and 4 for left main bronchus obstruction (3 ETS).Nine pts were lost to follow-up. After a mean of 10 ± 7 years, there were 6 latedeaths for a 18 year survival of 94% (95% CI: 84–97%). Pts operated with ETS hadbetter chances of survival (18 year survival 95% (95% CI: 86–98%) vs 77% (95%CI: 44–92%). By multivariate analysis the only predictive factor of late mortalitywas post-operative occurrence of left main bronchus compression (p < 0.005). Followinghospital discharge, 18 pts had to undergo further aortic arch interventionby surgery (5), catheter intervention (7), or both (3). The only factor predictive ofearly or late arch reintervention was initial procedure performed through thoracotomy(p = 0.001). Freedom from arch reintervention after ETS repair was 75% at 18years (95% CI: 56–87%). On echocardiography, an additional 16 pts were identifiedto have a residual gradient higher than 25 mm Hg. The 18 year freedom fromhypertension was 88% (95% CI: 72–95%).190
AMERICAN ASSOCIATION FOR THORACIC SURGERYCONCLUSION: One-stage repair with end-to-side anastomosis seems to be theoptimal approach for neonates born with interrupted aortic arch. It provided longlastingrelief of the arch obstruction with low early mortality. After two decades ofexperience with this approach, the incidence of late hypertension seems minimal.The need for further arch reintervention warrants close follow-up of these patients.TUESDAYAfternoon191
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Boston - American Association for Thoracic Surgery

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