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

Abstract

Objectives: Mortality in patients with interrupted aortic arch (IAA) rates among the highest in congenital heart surgery. Various techniques for aortic arch repair are described; reintervention rates remain substantial. This retrospective single-centre study aimed 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 IAA were operated between 1999 and 2023. Median age at operation was 10 [7; 15] days and weight was 3.3 [3; 3.7] kg. In the 24 children with ventricular septal defects (VSDs) only, the arch was repaired by a direct anastomosis. Thirty-four had complex concomitant heart defects, and the arch reconstruction was performed by direct anastomosis (20), direct anastomosis + patch (10), reverse subclavian flap + patch (3) and aortic autograft + patch (1).

Results: Median cardiopulmonary bypass time was 222 [159; 315] min, and aortic cross-clamp time was 94 [75; 143] min. Two patients died during the hospital stay (4%), two patients after discharge (4%), and four (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 IAA was 7%, and the arch reintervention rate was 8%. Direct aortic anastomosis in patients with VSD can only be performed with excellent outcomes, with no deaths or arch reinterventions being observed after a follow-up up to 24 years.

Clinical registration number: EK Nr 1268/2021, Ethics committee of the Medical Faculty at Johannes Kepler University Linz.