REPAIR OF AORTIC-ARCH INTERRUPTION BY DIRECT ANASTOMOSIS

Objective: Evaluation of surgical treatment of interrupted aortic arch (IAA) by direct anastomosis. Methods: A consecutive series of 17 infa nts with IAA (type A in eight patients, type B in nine) were operated upon. The mean age at arch repair was 1.0 month (range 0.2-7.7), mean weight was 3.7 kg (range 2.2-6.2). All arch repairs were done by direc t anastomosis. This included a persistent arterial duct in one and a s ubclavian turnup in another case. The aortic reconstruction included r eimplantation of a lusoric artery in three patients? patch enlargement of the ascending aorta in three and of the complete arch in one patie nt. The arch repair was done through a lateral thoracotomy in three pa tients. In 14 patients the aortic repair was part of a single-stage ap proach through a median sternotomy using cardiopulmonary bypass and ci rculatory arrest. Results: There was no operative mortality. One patie nt (single-stage approach) died 2 days after operation due to respirat ory problems caused by tracheobronchomalacy. One patient (lateral appr oach) died suddenly 3 months after aortic repair and banding. Median f ollow up was 4.8 years (range 0.1-12.9). In five patients restenosis o f the aortic arch developed, all within 1.5 years after repair. This w as not correlated with the type of interruption, weight at operation, age at operation or the surgical approach. The actuarial freedom from restenosis was 61% at 5 years with a 70% confidence limit (CL(70%)) of 46-75, All restenoses were balloon dilated, but two needed redo surge ry, which was done by the median approach. In three patients discrete subaortic stenosis developed. This was not correlated with the type of interruption, weight at operation, age at operation or the surgical a pproach. The actuarial freedom from subaortic stenosis was 68% at 5 ye ars (CL(70%) = 54-83). These stenoses were treated by enucleation, fol lowed;ed in one patient by a pulmonary autograft procedure for recurre nt root stenosis after another year. At the end of follow up all patie nts were thriving well, lacked symptoms, were normotensive and had nor mal femoral artery pulsations. Conclusions: IAA can be treated well wi th primary anastomosis. Possible restenosis of the aortic arch can ade quately be treated by percutaneous balloon dilatation or redo surgery if necessary. Arch repair by median single-stage approach has our pref erence. Copyright (C) 1997 Elsevier Science B.V.