title: Outcomes of interrupted aortic arch repair using the carotid artery turndown procedure.
abstract: OBJECTIVE
  Interrupted aortic arch is a rare congenital anomaly affecting 1.5% of infants with congenital heart disease. Multiple surgical modalities exist to address this defect. We evaluate the long-term outcome of interrupted aortic arch with the left carotid artery turndown technique from a single institution.
  
  
  METHODS
  Patients with interrupted aortic arch who underwent the carotid turndown procedure were identified between September 1982 and March 2010. Medical and surgical records were reviewed. Mortality data were obtained from state death records.
  
  
  RESULTS
  Forty-seven patients met inclusion criteria. Median follow-up was 6.2 years (5 days to 23.2 years). Twenty-one patients (45%) had genetic syndromes. There were 4 operative deaths (8.5%) and 9 late deaths (19%). One-year and 5-year survivals were 80.2% and 72.6%, respectively. Seventeen patients (36.2%) required reoperation or other interventions on the aortic arch.
  
  
  CONCLUSIONS
  Left carotid artery turndown offers a favorable surgical outcome. It compares with end-to-end repair, while providing a tension-free anastomosis and avoiding neonatal circulatory arrest and cardiopulmonary bypass. Disadvantages include a 2-stage repair and a significant reintervention rate, particularly when compared with the aortic arch advancement technique. Nevertheless, the reduced exposure to circulatory arrest and bypass and avoidance of left bronchial obstruction are important considerations that may offset these limitations.
authors.affiliation: Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, Ind, USA.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Todman
authors.forename: Osama
authors.initials: O
authors.lastname: Eltayeb
authors.forename: Mark
authors.initials: M
authors.lastname: Ruzmetov
authors.forename: Mark D
authors.initials: MD
authors.lastname: Rodefeld
authors.forename: Mark W
authors.initials: MW
authors.lastname: Turrentine
authors.forename: John W
authors.initials: JW
authors.lastname: Brown
authors.forename: John P
authors.initials: JP
authors.lastname: Breinholt
mesh_terms: D000714:Anastomosis, Surgical; D001013:Aorta, Thoracic / Q000002:abnormalities / Q000601:surgery*; D017536:Carotid Artery, Common / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007196:Indiana; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000401:mortality / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality