Rapid two-stage versus one-stage surgical repair of interrupted aortic arch with ventricular septal defect in neonates.
OBJECTIVE
The optimal management of interrupted aortic arch (IAA) with ventricular septal defect is controversial. The aim of this study was to evaluate our 12 years of experience of surgical outcomes of one-stage and rapid two-stage total corrections of IAA with ventricular septal defect and to delineate the management of postoperative complications.


METHODS
We reviewed the medical charts of all patients from 1996 to 2007. Neonates with inherent complex anatomy were excluded. There were 26 patients in our series, with 11 type A and 15 type B IAA. Nineteen patients received one-stage repair and seven patients received rapid two-stage total correction. Rapid two-stage total correction was defined as two operations performed within 1 week.


RESULTS
The 1-month postoperative survival rate was 81% (21/26), with 79% (15/19) in the one-stage group, and 86% (6/7) in the rapid two-stage group. The rapid two-stage group had a shorter cardiopulmonary bypass time (160.1 +/- 58.4 vs. 216.8 +/- 73.7 minutes, p = 0.054) and aortic cross clamp (AXC) time (65.6 +/- 24.4 vs. 91.8 +/- 22.4 minutes, p = 0.022) than the one-stage group. Postoperative left ventricular outflow tract obstruction (LVOTO) and aortic arch restenosis were common in survivors, with frequencies of 48% (10/21) and 71% (15/21) respectively. Within the postoperative arch stenosis subgroup, nine out of 15 patients received balloon angioplasties, which proved effective after only one treatment. The overall late survival rate was 73% (19/26), with 68% (13/19) in the one-stage group, and 86% (6/7) in the rapid two-stage group.


CONCLUSIONS
The outcome of rapid two-stage repair is comparable to that of one-stage repair. Rapid two-stage repair has the advantages of significantly shorter cardiopulmonary bypass duration and AXC time, and avoids deep hypothermic circulatory arrest. LVOTO remains an unresolved issue, and postoperative aortic arch restenosis can be dilated effectively by percutaneous balloon angioplasty.
Lee
Meng-Lin
ML
Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Chang
Chung-I
CI
Huang
Shu-Chien
SC
Chen
Yih-Sharng
YS
Chiu
Ing-Sh
IS
Wu
En-Ting
ET
Chen
Chun-An
CA
Chiu
Shuenn-Nan
SN
Lin
Ming-Tai
MT
Wang
Jou-Kou
JK
Wu
Mei-Hwan
MH
D001013:Aorta, Thoracic; D001024:Aortic Valve Stenosis / Q000209:etiology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications* / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011182:Postoperative Care; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome