TY - JOUR
T1 - Preoperative echocardiographic measures in interrupted aortic arch
T2 - Which ones best predict surgical approach and outcome?
AU - Abarbanell, Ginnie
AU - Border, William L.
AU - Schlosser, Brian
AU - Morrow, Gemma
AU - Kelleman, Michael
AU - Sachdeva, Ritu
N1 - Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - 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.
AB - 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.
KW - Interrupted aortic arch
KW - Yasui operation
KW - left ventricular outflow obstruction
UR - http://www.scopus.com/inward/record.url?scp=85048298771&partnerID=8YFLogxK
U2 - 10.1111/chd.12599
DO - 10.1111/chd.12599
M3 - Article
C2 - 29520990
AN - SCOPUS:85048298771
SN - 1747-079X
VL - 13
SP - 476
EP - 482
JO - Congenital Heart Disease
JF - Congenital Heart Disease
IS - 3
ER -