Optimal surgical approach for repair of aortopulmonary window

Background: This is a review of the experience over 26 year in a single ins titution with surgical repair of aortopulmonary window. Methods: Between Ju ly 1973 and March 1999, 38 patients underwent surgery for aortopulmonary wi ndow at a median age of 5 weeks, and with a median weight of 3.9 kg. Median follow-up was 6.6 years, with a range from 0.8 to 26 years. Additional def ects were present in 25 (65%) patients, including interruption of the aorti c arch in 7, tetralogy of Fallot in 7, ventricular septal defect in 5, func tionally univentricular anatomy in 3, aortic coarctation in 2, and anomalou s origin of a coronary artery in 1. We approached via an aortotomy in 45%, an incision through the defect in 31%, and using a pulmonary arteriotomy in 24% of patients. Closure was achieved using a single patch in 30 patients (79%). Results: There were 3 (7.9%) in-hospital deaths. Actuarial patient s urvival was 88% at 10 years. Three patients required reinterventions for st enoses of the great arteries. Freedom from any reintervention was 70% at 10 years. By multivariate analysis, the approach through a pulmonary arteriot omy was shown to result in a higher need for reintervention (p = 0.01). Con clusions: Repair of aortopulmonary window can be done with excellent result s. A pulmonary arteriotomy should be avoided.