Outcomes following surgical repair of aortic arch obstructions with associated cardiac anomalies

Abstract

To assess outcomes of surgical repair of aortic arch obstructions with associated cardiac anomalies, we reviewed our institutional experience. Between 1995 and 2005, 90 consecutive patients with interrupted aortic arch (n=25) or coarctation of the aorta (n=65) and cardiac anomalies underwent biventricular repair. Coexisting cardiac anomalies included ventricular septal defect (VSD, n=69), transposition of the great arteries (n=11), Taussig-Bing heart (n=4), double-outlet right ventricle with subaortic VSD (n=1), atrioventricular septal defect (n=4), and an aortopulmonary window (n=1). Arch reconstruction was accomplished by a subclavian flap aortoplasty in 12 patients, end-to-end anastomosis in 23, and end-to-side anastomosis in 55. The overall early and late mortalities were 5.6% (n=5) and 6.7% (n=6), respectively. The overall survival was 87%+/-3.7% at 10 years. Mortalities for VSD and for complex cardiac anomalies were 4.4% and 7.8%, respectively. Univariate analysis identified types of associated cardiac anomalies as a predictor for death, with the survival of patients with VSD significantly better than the other complex cardiac anomalies (p<0.05). There was a trend for single-stage repair to be associated with lower mortality compared with staged repair (p=0.06). No patients undergoing end-to-side arch reconstruction had a recurrent obstruction. The type of associated intracardiac anomalies with arch obstruction influenced postoperative outcomes. Although both approaches could achieve good results, our data suggest that single-stage repair for arch obstruction with VSD may be associated with better survival, and is therefore recommended.