BIVENTRICULAR REPAIR OF CONOTRUNCAL ANOMALIES ASSOCIATED WITH AORTIC-ARCH OBSTRUCTION - 103 PATIENTS

Background Biventricular repair of conotruncal anomalies associated wi th aortic arch obstruction is a complex surgical procedure that combin es a cardiac repair and a aortic arch reconstruction. Methods and Resu lts From January 1984 to April 1996, such a repair was performed in 10 3 patients. The conotruncal anomalies included: 15 transpositions of t he great arteries (TGAs) with intact ventricular septum, 44 TGAs with ventricular septal defect, 32 double outlet right ventricle with subpu lmonary ventricular septal defect, 10 truncus arteriosus, one double o utlet left ventricle. and one tetralogy of Fallot. The arch obstructio n included 88 coarctation and 15 interrupted aortic arch. One-stage re pair has been the favored technique since 1990 and was performed in 58 neonates, including 38 TGAs or double outlet right ventricle and vent ricular septal defect, 10 TGAs with intact ventricular septum, and all of the 10 truncus arteriosus. The cardiac repair included 89 arterial switch operations, 2 Kawashima rerouting, 10 truncus arteriosus repai rs, and one double-outlet left ventricle repair and one tetralogy of F allot repair. The aortic arch was reconstructed by direct anastomosis in 85 patients, with a Gore-Tex conduit in three patients and more rec ently by an ascending aortic patch augmentation in 15 patients. The ho spital mortality was 12% (7 of 58) for the one-stage repair and 20% (9 of 45) for the two-stage repair. There were six late deaths. Reoperat ions or angioplasties were mandatory for 12 right ventricle outflow tr act obstructions after arterial switch, involving 10 patients with dou ble outlet right ventricle (P = .02), 10 recurrent arch obstruction, a nd six miscellaneous lesions. Conclusions One-stage biventricular repa ir of conotruncal anomalies associated with aortic arch obstruction ca n be achieved in selected patients with an 83% survival rate at 7 year s.