Surgical results of interrupted aortic arch repair in 181 patients with biventricular circulation.

T. Harada¹, T. Nakano², R. Hosoda¹, S. Fujita², T. Nagase^2
1Fukuoka children's hospital, Fukuoka city, Fukuoka ²Fukuoka Children's Hospital, Fukuoka, Fukuoka

Purpose: In recent years, surgical outcomes for interrupted aortic arch (IAA) repair have improved. However, challenges persist, particularly in cases with complex cardiovascular anomalies. This study reviews our 40-year experience in a single center, assessing the current surgical outcomes including the re-intervention rate on the aortic arch according to operative strategies.

Methods: We conducted a retrospective review of 181 patients with interrupted aortic arch (IAA) and biventricular physiology who underwent surgical intervention at our institution between June 1982 and May 2022. The patients were divided into subtypes: 108 cases were classified as type A, 72 cases as type B, and 1 case as type C. Based on associated anomalies, the patients were categorized into two groups: the simple group (SG; n=121) included ventricular septal defects (n=114) and aortopulmonary windows (n=7), while the complex group (CG; n=60) included double outlet right ventricle (n=17), transposition of the great arteries (n=11), and truncus arteriosus (n=16). The median follow-up duration was 13.7 years, ranging from 0 to 17.9 years.

Results: Six (3.3%) operative mortality and 9 (5.0%) late mortality occurred. The actuarial survival rates at 20 years postoperatively were 90.7%. The survival rates of SG and CG at 20 years were 94.7% and 82.9% (P=0.007). Furthermore, these rates at era1 and era2 were 91.7% and 96.8% (P=0.21), and 68.4% and 90.1% (P=0.012), respectively. One-staged repair was performed in 130 patients (71.8%), while 51 patients (28.2%) underwent two-staged repair. Throughout the study period, most patients in the SG underwent one-staged repair, whereas the proportion of CG patients undergoing two-staged correction increased, particularly since 2011. The mortality rate has improved since 2011, compared to the period before 2010 (P=0.02). As risk factors for mortality, multivariate analysis identified era1 and CG. Various surgical techniques were employed for arch repair, with the most common being end-to-side anastomosis (n=152). Other techniques included graft interposition (n=13), pulmonary artery roll (n=3), glutaraldehyde-treated autologous pericardium (n=2), and the others (n=11). Aortic arch reoperation was performed in 26 patients and the freedom rates from arch reoperation at 20 years improved over years with 74.8% and 89.8% in era1 and era2 (P=0.041). Risk factors for recurrent aortic arch obstruction in multivariate analysis were type of surgical approach and emergent operations.

Conclusion: In our study, we have observed a notable improvement in surgical outcomes for IAA and biventricular physiology, particularly in cases involving complex cardiac anomalies. This improvement can be attributed to the advancement of surgical techniques and the adoption of individualized surgical strategies, as well as advancements in perioperative management, which have collectively contributed to a significant reduction in postoperative mortality and morbidity. Nevertheless, it is crucial to maintain vigilant follow-up for the late development of the recurrence of aortic arch obstruction.

Identify the source of the funding for this research project: None.