Abstract 8911: Incidence and Risk Factors of Aortic Arch Obstruction After the Comprehensive Stage II Procedure

Abstract

Introduction: Minimal data exist about the incidence and risk factors for arch intervention after Comprehensive Stage II (CSII). Goal of this study was to document incidence of arch interventions after CSII and determine if any differences existed between those that underwent an arch intervention (aiCSII) versus those did not have an intervention. Methods: Retrospective chart review of all hypoplastic left heart syndrome patients that underwent a CSII between 6/1/2005 through 2/1/2020 was performed. Univariate analysis was conducted in addition to principal components analysis (PCA). Results: One hundred patients were evaluated. Sixteen patients underwent 24 arch interventions. Age at initial arch reintervention was 1.3 + 1.2 years (median 1.0 years, range 0.5 - 2.2 years). Univariate analysis showed that the aiCSII group were more likely to be female, to have had a retrograde arch intervention post-hybrid procedure, and to be younger at time of CSII. On echocardiograms, aiCSII group had significantly higher pre-CSII patent ductus arteriosus velocities, arch velocities on their 1 st post-operative and discharge study post-CSII, and arch velocities pre-Fontan. Gradients were higher in the aiCSII via pre-Fontan catheterization. With PCA, echocardiographic and catheterization data remained significantly associated with aiCSII versus those that did not undergo an arch intervention (OR = 4.5 (1.9, 19.8), p < 0.01). Mortality was not associated with arch intervention. Conclusions: Incidence of arch intervention post-CSII was 16%. Echocardiographic arch gradients during the CSII hospitalization were the strongest predictors for subsequent aortic arch interventions. Further studies are needed to determine any modifiable variables that may reduce the incidence of arch interventions.