ONE-STAGE NEONATAL REPAIR OF COMPLEX AORTIC-ARCH OBSTRUCTION OR INTERRUPTION - RECENT EXPERIENCE AT TEXAS CHILDRENS-HOSPITAL

The optimal surgical approach for complex aortic coarctation or an int errupted aortic arch with associated intracardiac defects is not unive rsally agreed upon. We reviewed our experience with 18 consecutive pat ients (10 with coarctation, 8 with interrupted aortic arch) undergoing a I-stage repair through median sternotomy between September of 1995 and February of 1997. Age at operation ranged from 3 days to 3 months (mean 23 days) and weight ranged from 1,700 g So 5,100 g (mean 3,350 g ). Under hypothermic circulatory arrest, the aortic arch was reconstru cted using native tissue-tissue anastomoses, and coexisting intracardi ac anomalies were repaired by standard techniques. All patients surviv ed the procedure and were ultimately discharged from the hospital. The re were 2 late deaths in the interrupted aortic arch group, I during r eoperation for subaortic stenosis and the other from noncardiac causes 5 months after discharge. Another interrupted aortic arch patient req uired a Ross-Konno procedure 8 months later: There has been no recoarc tation among the 16 survivors. Thus a 1-stage repair for complex aorti c arch obstruction in neonates can be accomplished with low operative risk, although long-term outcome is strongly influenced by the presenc e of subaortic obstruction.