CARDIOVASCULAR ENGINEERING Journal for Extracorporeal Circulation, Assist Devices,Transplantation and Artificial Organs
	Volume 3, 1998, No 1

Primary Surgical Reconstruction of Interrupted Aortic Arch in Neonates: Technique and Results

T. Tlßskal, B. Hucín, M. Kostelka, R. Gebauer, J. JanouÜek,V. Kucera, J. Marek, V. Chaloupecký, J. Škovrßnek

Abstract:
Background: Interrupted aortic arch (IAA) represents a critical congenital heart disease with a high mortality in the neonatal period. The primary repair in neonates might have advantages in comparison with a two-stage repair, but surgical mortality in some series remains high. Methods: Between 1993-1996, 14 neonates aged 1-26 days (median 5 days) underwent primary repair of IAA. Prostaglandins, correction of metabolic acidosis and treatment of complications were necessary before surgery. Correction was performed from the midline sternotomy approach, in extracorporeal circulation and deep hypothermia. Circulatory arrest at 14-19oC was used for arch reconstruction and after extensive mobilization direct end to side anastomosis between descending and ascending aorta was always possible. Then, on cardiopulmonary by-pass, associated heart lesions were corrected (ventricular septal defect in 12, truncus arteriosus in 2, subaortic stenosis in 2, transposition of the great arteries, double-outlet right ventricle and aortico-pulmonary window in 1 patient, each). Results: Four (28.6%) patients died after surgery. Out of the first 6 patients 3 (50.%) died, but out of the subsequent 8 patients only 1 (12.5%) died. Reinterventions for persistent subaortic stenosis and for left bronchus compression were necessary in one patient each. All 10 early survivors are alive and doing well 12-48 months after the repair. All patients have a nonrestrictive aortic anastomosis. Conclusion: Primary repair of IAA and associated lesions can be performed in a neonate with reasonable mortality. Treatment of severe complications is necessary before surgery which must be performed as soon as possible. Results depend on the patient’s clinical condition and experience of the center.

Keywords:
Congenital heart disease, interrupted aortic arch, associated heart lesions, neonate, cardiac surgery, primary repair, surgical technique, deep hypothermia, circulatory arrest, results

Address for Correspondence:

Reference:
(CVE. 1998; 3 (1): 9-15)

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