title: Long-term outcomes of complete vascular ring division in children: a 36-year experience from a single institution.
abstract: Complete vascular rings are rare and cause tracheoesophageal compression. Following surgical division, some patients have persisting tracheomalacia. We aim to assess the long-term outcomes of complete vascular ring division.
  
  
  
  All patients (n = 132) who underwent surgical division of a complete vascular ring between 1978 and 2014 were identified from the hospital database and retrospectively reviewed.
  
  
  
  Complete vascular rings consisted of a double aortic arch (n = 80), right aortic arch with an aberrant subclavian artery and left ligamentum arteriosum (n = 50), right aortic arch with mirror image branching and left ligamentum arteriosum (n = 1), and a left aortic arch with right descending aorta and right ligamentum arteriosum (n = 1). Kommerell's diverticulum was identified in 10 patients. Preoperative tracheomalacia was identified via bronchoscopy in 25 patients. Concomitant tracheal reconstruction was not performed in any patient. Kommerell's diverticulum was resected in 1 patient. The hospital mortality rate was 1.5% (2/132). There were no late deaths. The overall survival rate was 98.3 ± 1.2% (95% CI: 93.4, 99.6) at 20 years. Postoperatively, persistent tracheal compression was reported in 3 patients, and tracheomalacia in 16 patients. The rate of freedom from reoperation was 88.6 ± 4.0% (95% CI: 77.9, 94.3) at 20 years. No patient required tracheal surgery during the follow-up period. Follow-up was 92% (121/132) complete, with a median follow-up of 11.4 years (range 44 days to 36 years). At the last follow-up, 7 patients had mild tracheomalacia.
  
  
  
  Outcomes of division of a complete vascular ring are excellent. Tracheomalacia often improves following division of the vascular ring. Respiratory symptoms following complete vascular ring division are uncommon.
authors: Royal Children's Hospital, Melbourne, Australia.|University of Melbourne, Melbourne, Australia.|Murdoch Children's Research Institute, Melbourne, Australia.
authors: Phillip S
authors: PS
authors: Naimo
authors: Royal Children's Hospital, Melbourne, Australia.|University of Melbourne, Melbourne, Australia.|Murdoch Children's Research Institute, Melbourne, Australia.
authors: Tyson A
authors: TA
authors: Fricke
authors: Royal Children's Hospital, Melbourne, Australia.
authors: Julia S
authors: JS
authors: Donald
authors: Royal Children's Hospital, Melbourne, Australia.
authors: Elie
authors: E
authors: Sawan
authors: Royal Children's Hospital, Melbourne, Australia.|University of Melbourne, Melbourne, Australia.|Murdoch Children's Research Institute, Melbourne, Australia.
authors: Yves
authors: Y
authors: d'Udekem
authors: Royal Children's Hospital, Melbourne, Australia.|University of Melbourne, Melbourne, Australia.|Murdoch Children's Research Institute, Melbourne, Australia.
authors: Christian P
authors: CP
authors: Brizard
authors: Royal Children's Hospital, Melbourne, Australia.|University of Melbourne, Melbourne, Australia.|Murdoch Children's Research Institute, Melbourne, Australia.
authors: Igor E
authors: IE
authors: Konstantinov
mesh_terms: D000293:Adolescent; D000783:Aneurysm / Q000601:surgery*; D001013:Aorta, Thoracic; D001015:Aortic Arch Syndromes / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D001999:Bronchoscopy; D018376:Cardiovascular Abnormalities / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000002:abnormalities* / Q000601:surgery; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000601:surgery*
keywords: Complete vascular ring; Congenital heart disease; Surgery