RESULTS OF PRIMARY AND 2-STAGE REPAIR OF INTERRUPTED AORTIC-ARCH

Objective: Early results of primary and two-stage repair of interrupte d aortic arch have improved. Experience with different surgical approa ches should be analysed and compared. Methods: Forty neonates and infa nts with interrupted aortic arch underwent primary repair (19 patients ) or palliative operation (21 patients). Twenty (50%) patients were fo llowed-up for 5.1 +/- 4.3 years. All patients were regularly examined with the aim of determining clinical development, presence of residual lesions or complications and need for re-intervention. Aortic arch an d the left ventricular outflow tract growth were assessed by echocardi ographic examination. Data from hospital and outpatient department rec ords were analysed. Results: The early mortality was 61.9% after palli ative operations and 36.8% after the primary repair. Presence of compl ications (P < 0.001), earlier year of surgery (P < 0.01), bad clinical condition and acidosis (P < 0.05) represented statistically significa nt risk factors for death in the whole series. In seven (87.5%) out of eight early survivors, after the initial palliative operation, closur e of ventricular septal defect and debanding were done, and in three ( 37.5%) patients, re-operation for aortic arch obstruction was also req uired. Out of 12 patients, after the primary repair, one required earl y re-operation for persistent left ventricular outflow tract obstructi on and two needed late re-intervention for left bronchus obstruction. In three (25%) patients, after the primary repair, left ventricular ou tflow tract obstruction with a maximal systolic pressure gradient high er than 30 mmHg developed. At present, all 20 early survivors are aliv e. Five patients, after palliative operation, are in NYHA class I, but in three patients, who are in class III or IV, the outcome is influen ced by severe complications. All patients after the primary repair are in class I or II. Conclusions: Our experience confirmed better result s after the primary repair of interrupted aortic arch, which was assoc iated with lower mortality, prevalence of severe complications and nee d for re-intervention. Higher prevalence of subaortic stenosis after p rimary repair could be explained by patient selection early in our exp erience. We recommend the primary repair of interrupted aortic arch an d associated heart lesions in neonates, however, in unfavourable condi tions an individualised surgical approach with initial palliative surg ery should be considered. (C) 1998 Elsevier Science B.V. All rights re served.