Long-term outcome after repair of interrupted aortic arch in a single center.

Abstract

Objectives: Mortality in patients with interrupted aortic arch rates among the highest in congenital heart surgery. Various techniques for aortic arch repair are described, reintervention rates remain substantially. The aim of this retrospective single center study: To evaluate the long-term outcome in a biventricular series with a preferably performed direct anastomosis and one-stage repair.

Methods: At the Children's Heart Center Linz 58 biventricular patients with interrupted aortic arch were operated between 1999 and 2023. Median age at operation was 10 [7; 15] days, weight 3.3 [3; 3.7] kg. In the 24 children with VSDs only, the arch was repaired by a direct anastomosis. 34 had complex concomitant heart defects, the arch reconstruction was performed by direct anastomosis (20), direct anastomosis + patch (10), reverse subclavian flap + patch (3), aortic autograft + patch (1).

Results: Median cardiopulmonary bypass time was 222 [159; 315] min, aortic cross-clamp time 94 [75; 143] min. 2 patients died during the hospital stay (4%), 2 patients after discharge (4%), 4 (7%) required an arch reintervention during a follow-up period of median 9.3 [6.2; 17.2] years. There was no death or arch reintervention in the VSD group.

Conclusions: All-cause mortality in biventricular patients with interrupted aortic arch was 7%, arch reintervention rate 8%. Direct aortic anastomosis in patients with VSD only can be performed with excellent outcomes, with no deaths or arch reinterventions being observed after a follow-up up to 24 years.