Thorac Cardiovasc Surg 2012; 60 - V28
DOI: 10.1055/s-0031-1297418

Aortic arch reconstruction in neonates: factors influencing survival and arch re-intervention

A Rüffer 1, C Bechtold 1, S Potapov 2, A Purbojo 1, S Ihlenburg 1, M Glöckler 3, A Koch 3, RA Cesnjevar 1
  • 1Universitätsklinikum Erlangen der Friedrich-Alexander Universität Erlangen-Nürnberg, Abteilung für Kinderherzchirurgie, Erlangen, Germany
  • 2Universitätsklinikum Erlangen der Friedrich-Alexander Universität Erlangen-Nürnberg, Lehrstuhl für Biometrie und Epidemiologie, Erlangen, Germany
  • 3Universitätsklinikum Erlangen der Friedrich-Alexander Universität Erlangen-Nürnberg, Abteilung für Kinderkardiologie, Erlangen, Germany

Objectives: Outcome evaluation after aortic arch reconstruction (AAR) in neonates (<1 month) with interrupted aortic arch (IAA) or hypoplastic aortic arch (HyAA). Norwood procedures were excluded from the study.

Methods: Sixty-four consecutive neonates with IAA (n=10) or HyAA (n=54) underwent AAR with cardio pulmonary bypass between 03/2000 and 08/2011 in a single center. Early one-stage correction was performed in 45 patients (70.3%). Patients' median age was 8 days (2–30); median weight was 3.2kg (1.3–4.4). Associated anomalies included a large VSD (n=30), aorto-pulmonary-window (n=1), Taussig-Bing-complex (n=3), single-ventricle-morphology (n=10), d-TGA (n=5), l-TGA (n=2), and left ventricular outflow tract obstruction (LVOTO, n=12). Ten patients were classified as borderline hypoplastic left heart complex. Univariate risk analysis was performed to analyze diagnosis related, operative variables and techniques influencing survival or aortic arch re-intervention (balloon or surgery).

Results: Follow-up was complete with a mean duration of 4.4±3.3 years. Early mortality was 10.9%. D-TGA, omitted or fenestrated ASD-closure, and VSD-enlargement were associated with increased risk of early mortality (p=0.02, p=0.03 and p<0.01). Kaplan-Meier survival was 77% (95% confidence interval [CI], 67–86), 70% (CI 59–84%) and 70% (CI 59–84%) after 1, 5 and 10 years. Diagnosis related survival analysis showed higher risk for LVOTO, missing VSD, and secondary palliation (p<0.01, p=0.04, p<0.01). Aortic arch re-interventions were performed in 14 patients (21.9%). Freedom from re-intervention was 83% (CI 73–95%), 74% (CI 55–87%), and 61% after 1, 5, and 10 years, respectively. LVOTO, use of autologeous pericardium, and fenestrated VSD-closure were associated with higher risk of re-intervention (p<0.01, p<0.01, p=0.02). There was no difference between primary correction and palliation regarding survival or arch re-intervention.

Conclusions: AAR in neonates can be performed in uni-or biventricular pathway with acceptable results. Additional LVOTO and intact ventricular septum show decreased survival. Biventricular correction with fenestration is associated with higher risk of early mortality and arch re-intervention.