Repair of hypoplastic or interrupted aortic arch via sternotomy

T. R. Karl, S. Sano, W. Brawn, R. B B Mee

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Herein we describe our experience with repair of interrupted aortic arch and coarctation plus hypoplastic aortic arch in 55 consecutive infants (1984 to 1990). Median age at operation was 6 days and median weight 3.1 kg. Associated severe intracardiac anomalies were the rule. All patients had significant congestive cardiac failure, and the majority required prostaglandin E1 resuscitation and inotropic support (with or without ventilation) before the operation. All operations were performed via sternotomy with core cooling and circulatory arrest. Isolated myocardial perfusion was used in 13 patients during arch repair. A complete intracardiac (biventricular) repair was performed except in patients expected to require a Fontan operation as definitive treatment. The operative mortality overall was 14.5% (confidence limits 10% to 22%). For arch repair plus biventricular intracardiac repair, the operative mortality was 9% (confidence limits 5% to 15%), and for arch repair plus palliative intracardiac repair, 40% (confidence limits 22% to 60%). The mortality in the isolated myocardial perfusion group was 0% (confidence limits 0% to 14%), which may be related to reduced myocardial ischemic time (p <0.05). Actuarial survival was 75% (confidence limits 65% to 83%) at 12 months, with no subsequent deaths over 1294 patient-months (mean 28 months) of follow-up. Actuarial freedom from recurrent arch obstruction was 69% (confidence limits 48% to 85%) at 46 months' follow-up. Primary repair of interrupted aortic arch and coarctation plus hypoplastic arch compares favorably with a staged approach and is recommended even when complex intracardiac anatomy is present.

Original languageEnglish
Pages (from-to)688-695
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume104
Issue number3
Publication statusPublished - 1992
Externally publishedYes

Fingerprint

Sternotomy
Thoracic Aorta
Aortic Coarctation
Mortality
Perfusion
Fontan Procedure
Alprostadil
Resuscitation
Ventilation
Anatomy
Heart Failure
Weights and Measures
Survival
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Karl, T. R., Sano, S., Brawn, W., & Mee, R. B. B. (1992). Repair of hypoplastic or interrupted aortic arch via sternotomy. Journal of Thoracic and Cardiovascular Surgery, 104(3), 688-695.

Repair of hypoplastic or interrupted aortic arch via sternotomy. / Karl, T. R.; Sano, S.; Brawn, W.; Mee, R. B B.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 104, No. 3, 1992, p. 688-695.

Research output: Contribution to journalArticle

Karl, TR, Sano, S, Brawn, W & Mee, RBB 1992, 'Repair of hypoplastic or interrupted aortic arch via sternotomy', Journal of Thoracic and Cardiovascular Surgery, vol. 104, no. 3, pp. 688-695.
Karl, T. R. ; Sano, S. ; Brawn, W. ; Mee, R. B B. / Repair of hypoplastic or interrupted aortic arch via sternotomy. In: Journal of Thoracic and Cardiovascular Surgery. 1992 ; Vol. 104, No. 3. pp. 688-695.
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