One-stage Repair of Aortic Arch Anomalies and Intracardiac Defects through Median Sternotomy

Sung, Si Chan; Chang, Yun Hee; Lee, Sang Kwon; Lee, Hyung Doo; Kim, Siho; Yie, Kilsoo; Woo, Jong Soo; Lee, Young Seok

Abstract

BACKGROUND: One-stage repair of aortic arch anomalies and intracardiac defects through median sternotomy has been recently adopted by many institutions since it is known to be safer than the staged repair. The early and midterm results of the one-stage repair of aortic arch anomalies and intracardiac defects were retrospectively evaluated. MATERIAL AND METHOD: 45 patients who underwent one-stage repair of aortic arch anomalies and intracardiac defects performed by one surgeon from January 1996 to July 2003 were included in this retrospective study. The median age of repair was 16 days (range, 3 days~23.7 months) and the mean weight was 3.62+/-1.30 kg. Thirty one (68.9%) had coarctation and 14 (31.1%) had interrupted aortic arch. Associated intracardiac anomalies were VSD in 31 patients (VSD group), TGA or Taussig-Bing anomaly in 10 (TGA group), and others in 4 (ASD in 1, aortopulmonary window 1, truncus arteriosus 1, aortic and mitral stenoses 1, miscellaneous group). The arch obstruction was repaired with end-to-side anastomosis in 23 patients and end-to-end anastomosis in 22. RESULT: Overall postoperative hospital mortality was 22.2% (10/45); 16.1% (5/31) in VSD group, 40% (4/10) in TGA group, and 25% (1/4) in miscellaneous group. There was no mortality in VSD group since 1998, and the mortality in TGA group has remarkably reduced since technical modification for coronary transfer was adopted (75% vs 16.7%). There was no postoperative seizure or other neurological complications. Postoperative aortic restenosis occurred in 5 patients (5/35, 14.3%). Two patients underwent balloon aortoplasty with successful results. There was no reoperation. There was one late death caused by pneumonia 5 months after the operation. Two-year actuarial survival rate including operative death was 72.9%.
CONCLUSION
The operative mortality of one-stage repair has been reduced with time and aortic restenosis rate was also acceptable. We concluded that this procedure is a reproducible procedure for aortic arch anomalies associated with intracardiac defects.