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Ann Thorac Surg 1999;68:2293-2297
© 1999 The Society of Thoracic Surgeons
a Division of Cardiovascular Surgery, The Hospital For Sick Children, Toronto, Ontario, Canada
b Division of Pediatric Cardiology, The Hospital For Sick Children, Toronto, Ontario, Canada
Address reprint requests to Dr Van Arsdell, Division of Cardiovascular Surgery, The Hospital For Sick Children, 555 University Ave, Suite 1525, Toronto, ON, Canada M5G 1X8
e-mail: glen.vanarsdell{at}sickkids.on.ca
Presented at the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.
Background. Results of aortic arch reconstruction in the setting of biventricular physiology are well documented in the adult population, however, in children, surgical outcome of this subgroup of patients is less clear.
Methods. We studied the clinical outcomes of 37 children aged 8 days to 15 years (median 26 months), who underwent aortic arch reconstruction for arch hypoplasia from 1982 to 1997. The children were divided into three groups: Group 1 (20 patients) had isolated aortic arch lesions, Group 2 (13 patients) had associated intra-cardiac pathology yet conserving a biventricular physiology, Group 3 (4 patients) had Williams Syndrome. Previous interventions for coarctation had been performed in 30 patients (81%). Arch repair consisted of a patch aortoplasty in the majority of patients (35 of 37 children).
Results. Operative mortality occurred in 5 children, 4 in Group 2 (31%), 1 in Group 3 (25%) and none in Group 1. Permanent neurological complications occurred in 2 children (5 %). During the follow-up, which ranged from 1 month to 8 years, balloon angioplasty for arch obstruction was required in 1 child. There was one late death, associated with a subsequent intra-cardiac repair.
Conclusions. Aortic arch surgery in children with isolated arch hypoplasia, is associated with excellent early and late survival in addition to a low reintervention rate. Alternative perfusion and operative strategies must be implemented in infants with associated intra-cardiac anomalies to improve results.
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