Original article
One-stage repair of transposition complex and interrupted aortic arch in children
Liang Zhang, MD1 (mhwzyh@163.com); Muzi Li, MD2 (limuzifw@163.com); Shoujun Li, MD1 (kszcyh@sina.com); Jun Yan, MD1(jiadetgyx@163.com); Qiang Wang, MD1 (txzzyx@sina.com)
1Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
2Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
Short running title: Interrupted aortic arch repair
Corresponding Author:
Qiang Wang, MD
Fuwai Hospital, 167 Beilishi Road, Xicheng District, Beijing, China
Phone: 86-13691061902
Fax: 86-010-88398496
E-mail address: txzzyx@sina.com
Ethics and integrity policy statements:
Abstract:
Background/Aim: A transposition complex with an interrupted aortic arch (IAA) is rare and surgically challenging because of its anatomical diversity and complexity. Herein, we aimed to present our 20-year experience with one-stage arterial switch surgery associated with IAA repair.
Methods: From January 2000 to April 2017, 11 patients were diagnosed with transposition complex and IAA and underwent one-stage repair at our center. These patients were retrospectively reviewed. Two patients had transposition of the great arteries, while the others had double outlet right ventricles, of whom eight had subpulmonary ventricular septal defects (Taussig-Bing anomalies), and one had a non-committed ventricular septal defect. In terms of the IAA, three patients underwent repair by extended end-to-end anastomosis, and one 16-mm prosthetic vascular graft was replaced in an elder patient. The remaining patients underwent autologous pericardial patch enlargement. All the variables were summarized and reported with descriptive statistics.
Results: Three early deaths occurred in this study. The median follow-up time was approximately 5 years (range: 3 – 14 years). No late deaths were reported. Only one patient required percutaneous re-intervention for recurrent coarctation. Moderate aortic regurgitation was observed in three patients. However, there was no requirement for aortic valvuloplasty or valve replacement. One patient had more than moderate tricuspid regurgitation. The other survivors are presently healthy.
Conclusions: Although one-stage repair for transposition complex and IAA still has non-negligible mortality even in older children, the late outcomes of survivors are acceptable. Owing to the high rate of valve regurgitation, closer follow-up is necessary for these patients.
Keywords: Congenital heart disease, transposition complex, interrupted aortic arch (IAA), one-stage repair, cardiac surgery
Introduction:
Patients with transposition complex and interrupted aortic arch (IAA) are very rare. It has been reported that only 6–10% of infants with IAA have transposition of the great arteries (TGA).1In the past, a staged repair was preferred. Primary IAA repair was performed via a left thoracotomy, followed by an arterial switch operation (ASO) after several months, which has been reported to be associated with high mortality. During the last two decades, a one-stage repair of IAA at the same time as ASO has been generally accepted as the treatment of choice.2
However, even in the recent era, these patients still represent a high-risk subgroup of candidates, and only a few reports have been published on this group. Herein, we report our surgical experience using several approaches since the year 2000 with one-stage ASO and IAA repair.
Materials and Methods: