Preoperative echocardiographic measures in interrupted aortic arch: Which ones best predict surgical approach and outcome?. (9th March 2018)

• Record Type: Journal Article
• Authors: Abarbanell, Ginnie; Border, William L.; Schlosser, Brian; Morrow, Gemma; Kelleman, Michael; Sachdeva, Ritu
• Is Part Of: Congenital heart disease. Volume 13:Number 3(2018)
• Page Start: 476
• Page End: 482
• Publication Date: 2018-03-09
• Subjects: Interrupted aortic arch -- left ventricular outflow obstruction -- Yasui operation; Congenital heart disease -- Periodicals; 616.1204305
• DOI: 10.1111/chd.12599
• Languages: English
• ISSNs: 1747-079X

Abstract

Abstract: Objective: It is unclear whether neonates with interrupted aortic arch (IAA) and a smaller left ventricular outflow tract may have improved outcomes with a Yasui operation (ventricular outflow bypass procedure) over a primary complete repair. This study sought to identify preoperative echocardiographic parameters to differentiate which neonates may have improved outcomes with a primary vs Yasui operation. Design: Patient demographics, cardiac surgery type, complications, need for reoperation and/or interventional catheterization, and date of last follow‐up were collected on neonates who underwent a biventricular repair for IAA from 2003 to 2014. Preoperative echocardiograms were analyzed for: IAA type, valve annulus size, aortic valve morphology, ventricular size and aortic arch anatomy. Results: Seventy‐seven neonates underwent IAA repair between 2003 and 2013. 60 neonates had a primary repair and 17 a Yasui operation. Neonates that underwent a Yasui operation had significantly smaller mitral and aortic valves with aortic arch hypoplasia. Within the primary repair group, a decreasing aortic root z ‐score on univariate analysis increased the odds of reoperation by twofold [OR = 1.98, 95% CI: (1.15‐3.42), P = .014]. A significant interaction between repair type and aortic root z ‐score was identified on multivariable analysis ( P = .039), for neonates with aortic root z ‐scores less than −2.5, the probability of reoperation during the follow up time period [mean 4.5 years (3.3 months‐10 year)] was significantly higher in the primary repair group compared to the Yasui group (64.3% vs 37.5%). Conclusions: Neonates with IAA and an aortic root z ‐score less than −2.5 have lower odds of subsequent reoperations with a Yasui operation compared to a primary repair over the follow up period. These findings suggest a Yasui operation should be considered if the preoperative aortic root z ‐score is less than −2.5. Careful evaluation of these morphologic predictors on preoperative echocardiograms can be helpful in surgical planning in neonates with IAA.