Surgical management of severe aortic outflow obstruction in lesions other than the hypoplastic left heart syndrome

Use of a pulmonary artery to aorta anastomosis

Jack Rychik, Kenneth A Murdison, Alvin J. Chin, William I. Norwood

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Between December 1985 and April 1990, 50 infants with a variety of congenital cardiac lesions other than the hypoplastic left heart syndrome underwent surgical relief of aortic outflow obstruction by creation of a pulmonary artery to aorta anastomosis. The patients were grouped anatomically by ventriculoarterial alignment. Nineteen had normally aligned great arteries (group I); 25 had transposition of the great arteries, all with a univentricular heart of left ventricular morphology (group II): and 6 had a double-outlet right ventricle (group III). All patients had either aortic stenosis with atresia, subaortic stenosis or a restrictive ventricular septal defect. Sixteen had normal arch anatomy; 34 had arch anomalies consisting of arch hypoplasia (n = 17), coarctation (n = 11), interruption of the arch (n = 4) and complex arch anomalies (n = 2). Surgery was performed at a median age of 10 days (range 2 to 184). Of the 50 infants, 33 survived. No significant difference in early survival (30 days) was noted among the groups of varying ventriculoanterial alignment (68% group I, 72% group II, 83% group III) (p < 0.05). Overall actuarial survival was 63% at 18 months. Analysis of actuarial survival by arch anatomy, although not statistically significant, revealed a trend toward better survival at 18 months postoperatively in infants with normal arch anatomy (81%) than in infants with arch anomalies (54%). Of the 33 survivors, 26 have proceeded to the next surgical stage, including the Fontan procedure in 8, superior cavopulmonary anastomosis in 13 and biventricular repair in 5. Equal early survival among patients in various anatomic groups of ventriculoarterial alignment can be successfully achieved after performance of a pulmonary artery to aorta anastomosis in infancy for severe aortic outflow obstruction. Arch anatomy appears to correlate with survival, with a higher mortality rate seen in infants with aortic arch abnormalities.

Original languageEnglish (US)
Pages (from-to)809-816
Number of pages8
JournalJournal of the American College of Cardiology
Volume18
Issue number3
DOIs
StatePublished - Jan 1 1991
Externally publishedYes

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Hypoplastic Left Heart Syndrome
Pulmonary Artery
Aorta
Anatomy
Survival
Actuarial Analysis
Right Heart Bypass
Double Outlet Right Ventricle
Fontan Procedure
Transposition of Great Vessels
Ventricular Heart Septal Defects
Aortic Valve Stenosis
Survival Analysis
Thoracic Aorta
Survivors
Pathologic Constriction
Arteries
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Surgical management of severe aortic outflow obstruction in lesions other than the hypoplastic left heart syndrome: Use of a pulmonary artery to aorta anastomosis",
abstract = "Between December 1985 and April 1990, 50 infants with a variety of congenital cardiac lesions other than the hypoplastic left heart syndrome underwent surgical relief of aortic outflow obstruction by creation of a pulmonary artery to aorta anastomosis. The patients were grouped anatomically by ventriculoarterial alignment. Nineteen had normally aligned great arteries (group I); 25 had transposition of the great arteries, all with a univentricular heart of left ventricular morphology (group II): and 6 had a double-outlet right ventricle (group III). All patients had either aortic stenosis with atresia, subaortic stenosis or a restrictive ventricular septal defect. Sixteen had normal arch anatomy; 34 had arch anomalies consisting of arch hypoplasia (n = 17), coarctation (n = 11), interruption of the arch (n = 4) and complex arch anomalies (n = 2). Surgery was performed at a median age of 10 days (range 2 to 184). Of the 50 infants, 33 survived. No significant difference in early survival (30 days) was noted among the groups of varying ventriculoanterial alignment (68{\%} group I, 72{\%} group II, 83{\%} group III) (p < 0.05). Overall actuarial survival was 63{\%} at 18 months. Analysis of actuarial survival by arch anatomy, although not statistically significant, revealed a trend toward better survival at 18 months postoperatively in infants with normal arch anatomy (81{\%}) than in infants with arch anomalies (54{\%}). Of the 33 survivors, 26 have proceeded to the next surgical stage, including the Fontan procedure in 8, superior cavopulmonary anastomosis in 13 and biventricular repair in 5. Equal early survival among patients in various anatomic groups of ventriculoarterial alignment can be successfully achieved after performance of a pulmonary artery to aorta anastomosis in infancy for severe aortic outflow obstruction. Arch anatomy appears to correlate with survival, with a higher mortality rate seen in infants with aortic arch abnormalities.",
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