REVISED TECHNIQUE OF CARDIOPULMONARY BYPASS IN ONE-STAGE REPAIR OF INTERRUPTED AORTIC-ARCH COMPLEX

Twenty infants with interrupted aortic arch associated with various in tracardiac anomalies under-went primary complete repair using pulsatil e high-flow cardiopulmonary bypass with a short period of circulatory arrest. Age at repair ranged from 11 to 126 days (mean age, 43 days). Weight ranged from 2.2 to 5.5 kg (mean weight, 3.4 kg). Associated car diac lesions included ventricular septal defect (14 patients), truncus arteriosus (3), transposition of the great arteries (2), and aortopul monary window (i patient). Left ventricular outflow tract obstruction was relieved in 2 patients. The aortic arch was reconstructed with a p olytetrafluoroethylene graft in 7 patients and by direct anastomosis i n the most recent 11 patients. An arterial cannulation method has been devised to facilitate direct anastomosis between the ascending aorta and the descending aorta, to lessen circulatory arrest time, and to pr event dangerous laceration and postoperative narrowing of the thin, sm all ascending aorta at the cannulation site. Two patients died, a surg ical mortality rate of 10%. There has been one late death, which was d ue to severe truncal valve insufficiency. The other patients are doing well with a mean follow-up of 3 years 6 months. Restenosis of the dir ect anastomosis has not been noted in any patient. However, subaortic stenosis with pressure gradients of 30 to 40 mm Hg developed in 3 pati ents. In conclusion, one-stage repair including direct anastomosis for the aortic arch reconstruction and repair of all coexisting intracard iac defects is thought to be the treatment of choice.