Open Access

ARTICLE

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

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1 Department of Pediatrics, Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, Missouri, USA
2 Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Children’s Healthcare of Atlanta and Sibley Heart Center Cardiology, Atlanta, Georgia, USA

* Corresponding Author: Ginnie Abarbanell, Department of Pediatrics, Division of Pediatric Cardiology, Washington University School of Medicine/ St. Louis Children’s Hospital, 660 South Euclid, Campus Box 8116, St. Louis, MO 63110. Email:

Congenital Heart Disease 2018, 13(3), 476-482. https://doi.org/10.1111/chd.12599

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.

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