Persistent risk of subsequent procedures and mortality in patients after interrupted aortic arch repair: A Congenital Heart Surgeons' Society study

    Authors

    A. Jegatheeswaran; B. W. McCrindle; E. H. Blackstone; M. L. Jacobs; G. K. Lofland; E. H. Austin; T. Yeh; V. Morell; J. P. Jacobs; R. A. Jonas; S. Cai; J. Rajeswaran; M. Ricci; W. G. Williams; C. A. Caldarone;W. M. DeCampli

    Comments

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    Abbreviated Journal Title

    J. Thorac. Cardiovasc. Surg.

    Keywords

    VENTRICULAR SEPTAL-DEFECT; OBSTRUCTION; EXPERIENCE; OUTCOMES; INFANCY; Cardiac & Cardiovascular Systems; Respiratory System; Surgery

    Abstract

    Objective: Multiple subsequent procedures directed at the arch and/or the left ventricular outflow tract are frequently required after interrupted aortic arch repair. We the investigated patterns and factors associated with these subsequent procedures and mortality. Methods: We reviewed the data from 447 patients with interrupted aortic arch at 33 institutions enrolled from 1987 to 1997. We classified the subsequent procedures by type (catheter-based or surgical) and focus (arch, left ventricular outflow tract, and "other" cardiovascular lesions). We used competing risks and modulated renewal analysis to explore subsequent procedures. Results: There were 158 subsequent arch and 100 left ventricular outflow tract procedures. Freedom from death at 21 years was 60% overall. The risk of additional subsequent arch procedures decreased after the first subsequent arch procedure in the acute phase, but did not significantly change in the chronic phase. The risk of additional subsequent left ventricular outflow tract procedures increased after the first subsequent left ventricular outflow tract procedure in the chronic phase. The risk factors for subsequent arch procedures and mortality, but not for subsequent outflow track procedures, were related in a complex way to previous procedures and their timing. Conclusions: Interrupted aortic arch is a chronic disease in which patients often undergo multiple subsequent procedures with persistent risk for additional intervention and mortality. The risk factors are related to the nature and timing of previous procedures and to the morphology and details of the index procedure. Interrupted aortic arch should be considered a chronic disorder. (J Thorac Cardiovasc Surg 2010;140:1059-75)

    Journal Title

    Journal of Thoracic and Cardiovascular Surgery

    Volume

    140

    Issue/Number

    5

    Publication Date

    1-1-2010

    Document Type

    Article

    Language

    English

    First Page

    1059

    Last Page

    U187

    WOS Identifier

    WOS:000283057600029

    ISSN

    0022-5223

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