PMID- 20207551
OWN - NLM
STAT- MEDLINE
DCOM- 20110322
LR  - 20191210
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 38
IP  - 1
DP  - 2010 Jul
TI  - Improved results after the primary repair of interrupted aortic arch: impact of a 
      new management protocol with isolated cerebral perfusion.
PG  - 52-8
LID - 10.1016/j.ejcts.2010.01.052 [doi]
AB  - OBJECTIVE: The aim of this retrospective study was to analyse results and risk 
      factors of death after the repair of the interrupted aortic arch, and to compare 
      results obtained with the use of deep hypothermic circulatory arrest versus 
      isolated cerebral perfusion. METHODS: The primary repair of the interrupted 
      aortic arch and associated heart lesions was performed in 50 consecutive 
      patients. The median age was 5 days and the mean weight was 3.1+/-0.6 kg. The 
      interrupted aortic arch was of type A in 12 (24%) patients, type B in 37 (74%) 
      and type C in one (2%) patient. Ventricular septal defect was present in 48 (96%) 
      patients, subaortic stenosis in 15 (30%), truncus arteriosus in 14 (28%), 
      transposition of the great arteries in two (4%), aortopulmonary window in two 
      (4%) and double-outlet right ventricle in one (2%). The surgery consisted of 
      reconstruction of the aortic arch by direct anastomosis and repair of associated 
      heart lesions. In 25 (50%) patients, aortic arch reconstruction was performed 
      using hypothermic circulatory arrest (group I) and in 25 by isolated cerebral 
      perfusion (group II). The duration of cardiopulmonary bypass, aortic 
      cross-clamping and circulatory arrest or isolated cerebral perfusion was 191+/-46 
      min, 90+/-24 min and 40+/-14 min, respectively, in group I; and 194+/-39 min, 
      74+/-20 min and 31+/-6 min, respectively, in group II. RESULTS: There were 10 
      (20%) deaths in this series, eight (32%) in group I and two (8%) in group II. Out 
      of 12 patients operated before 1995, seven (58%) patients died; and out of 38 
      patients operated between 1995 and 2009, three (8%) patients died (p=0.008). By 
      Cox multifactorial analysis, the earlier date of operation represented the only 
      risk factor of death (p=0.037). Twelve (71%) survivors in group I and five (22%) 
      survivors in group II required re-intervention, most often for subaortic 
      stenosis, aortic arch obstruction or conduit obstruction. All patients remain in 
      the New York Heart Association (NYHA) class I or II at median 12.6 years in group 
      I, and 1.7 years in group II, respectively, after surgery. CONCLUSIONS: 
      Interrupted aortic arch can be repaired in neonates with a mortality of 5-10%. 
      The results depend on experience. Isolated cerebral perfusion was joined with 
      decreased mortality but it did not influence the occurrence of neurological 
      complications.
CI  - Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by 
      Elsevier B.V. All rights reserved.
FAU - Tlaskal, Tomas
AU  - Tlaskal T
AD  - Kardiocentrum and Cardiovascular Research Center, University Hospital Motol, 
      Prague, Czech Republic. tomas.tlaskal@lfmotol.cuni.cz
FAU - Vojtovic, Pavel
AU  - Vojtovic P
FAU - Reich, Oleg
AU  - Reich O
FAU - Hucin, Bohumil
AU  - Hucin B
FAU - Gebauer, Roman
AU  - Gebauer R
FAU - Kucera, Vladimir
AU  - Kucera V
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20100306
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Anastomosis, Surgical/methods
MH  - Aorta, Thoracic/*abnormalities/*surgery
MH  - Blood Vessel Prosthesis Implantation/*methods
MH  - Cardiopulmonary Bypass
MH  - Cerebrovascular Circulation
MH  - Circulatory Arrest, Deep Hypothermia Induced/methods
MH  - Epidemiologic Methods
MH  - Female
MH  - Heart Defects, Congenital/surgery
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Reoperation/methods
MH  - Treatment Outcome
EDAT- 2010/03/09 06:00
MHDA- 2011/03/23 06:00
CRDT- 2010/03/09 06:00
PHST- 2009/09/29 00:00 [received]
PHST- 2010/01/08 00:00 [revised]
PHST- 2010/01/18 00:00 [accepted]
PHST- 2010/03/09 06:00 [entrez]
PHST- 2010/03/09 06:00 [pubmed]
PHST- 2011/03/23 06:00 [medline]
AID - S1010-7940(10)00116-8 [pii]
AID - 10.1016/j.ejcts.2010.01.052 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2010 Jul;38(1):52-8. doi: 10.1016/j.ejcts.2010.01.052. 
      Epub 2010 Mar 6.