Preoperative echocardiographic measures in interrupted aortic arch: Which ones best predict surgical approach and outcome?

Ginnie Abarbanell, William L. Border, Brian Schlosser, Gemma Morrow, Michael Kelleman, Ritu Sachdeva

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Objective: It is unclear whether neonates with interrupted aortic arch (IAA) and a smaller left ventricular outflow tract may have improved outcomes with a Yasui operation (ventricular outflow bypass procedure) over a primary complete repair. This study sought to identify preoperative echocardiographic parameters to differentiate which neonates may have improved outcomes with a primary vs Yasui operation. Design: Patient demographics, cardiac surgery type, complications, need for reoperation and/or interventional catheterization, and date of last follow-up were collected on neonates who underwent a biventricular repair for IAA from 2003 to 2014. Preoperative echocardiograms were analyzed for: IAA type, valve annulus size, aortic valve morphology, ventricular size and aortic arch anatomy. Results: Seventy-seven neonates underwent IAA repair between 2003 and 2013. 60 neonates had a primary repair and 17 a Yasui operation. Neonates that underwent a Yasui operation had significantly smaller mitral and aortic valves with aortic arch hypoplasia. Within the primary repair group, a decreasing aortic root z-score on univariate analysis increased the odds of reoperation by twofold [OR = 1.98, 95% CI: (1.15-3.42), P =.014]. A significant interaction between repair type and aortic root z-score was identified on multivariable analysis (P =.039), for neonates with aortic root z-scores less than −2.5, the probability of reoperation during the follow up time period [mean 4.5 years (3.3 months-10 year)] was significantly higher in the primary repair group compared to the Yasui group (64.3% vs 37.5%). Conclusions: Neonates with IAA and an aortic root z-score less than −2.5 have lower odds of subsequent reoperations with a Yasui operation compared to a primary repair over the follow up period. These findings suggest a Yasui operation should be considered if the preoperative aortic root z-score is less than −2.5. Careful evaluation of these morphologic predictors on preoperative echocardiograms can be helpful in surgical planning in neonates with IAA.

Original languageEnglish
Pages (from-to)476-482
Number of pages7
JournalCongenital Heart Disease
Volume13
Issue number3
DOIs
StatePublished - May 1 2018

Keywords

  • Interrupted aortic arch
  • Yasui operation
  • left ventricular outflow obstruction

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