The Limitation of Staged Repair in the Surgical Management of Congenital Complex Heart Anomalies with Aortic Arch Obstruction

Ryo Aeba, Toshiyuki Katogi, Kenichi Hashizume, Yoshimi Iino, Kiyoshi Koizumi, Kentaro Hotoda, Shinya Inoue, Hideki Matayoshi, Akihiro Yoshitake, Ryohei Yozu

Research output: Contribution to journalArticle

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Abstract

Objective: Severe aortic arch obstruction including an interrupted aortic arch in congenital complex heart anomalies remains a challenge in surgical management. Methods: Treatment and outcomes in 75 consecutive patients who underwent an aortic arch repair as the first step of the staged repair protocol between 1975 and 2000 were reviewed. Their ages at repair ranged from 1 day to 8.5 months. Results: Cross-sectional postoperative follow-up data were available in all the patients. The follow-up period ranged from 0 to 27.6 years (mean: 7.3 ± 7.3 years). There were 20 postoperative hospital deaths (27%) and 7 late deaths. The Kaplan-Meier estimate of survival was 81.3% ± 4.5% at 1 month, 68.0% ± 5.4% at 1 year, 65.0% ± 5.5% at 5 years, 63.1% ± 5.7% at 10 years, 63.1% ± 5.7% at 20 years. By Cox regression analysis, body weight of 2.5 kg or less is the only independent determinant of postoperative mortality (p = 0.04, multivariable odds ratio: 2.50, [95% confidence interval: 1.02-6.1]). The aortic arch morphology, the primary cardiac lesion, or date of operation did not reach a statistically significant level to show correlation with mortality. Reintervention to reconstruct the aortic arch was performed at 9 occasions in 8 of the 55 patients who survived the primary operation (14.5%). The Kaplan-Meier estimate of the reintervention-free rate was 91.3% ± 4.2% at 5 years, 85.5% ± 5.6% at 10 years, 75.6% ± 8.2% at 20 years. Using multivariable Cox regression analysis, interrupted aortic arch (versus aortic coarctation) was the only independent predictor of a shorter time to reintervention (p = 0.001, multivariable odds ratio: 16.1, [95% confidence interval: 3.2-80.2]). Conclusions: The staged repair protocol was associated with significant limitations in patient survival and with the development of recurrent aortic arch obstruction. Thus, a primary repair protocol may serve as an alternate approach, especially in patients with low weight or with an interrupted aortic arch.

Original languageEnglish
Pages (from-to)302-307
Number of pages6
JournalJapanese Journal of Thoracic and Cardiovascular Surgery
Volume51
Issue number7
Publication statusPublished - 2003 Jul

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Thoracic Aorta
Kaplan-Meier Estimate
Odds Ratio
Regression Analysis
Confidence Intervals
Aortic Coarctation
Survival
Mortality
Body Weight
Weights and Measures

Keywords

  • Aortic arch obstruction
  • Staged repair

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The Limitation of Staged Repair in the Surgical Management of Congenital Complex Heart Anomalies with Aortic Arch Obstruction. / Aeba, Ryo; Katogi, Toshiyuki; Hashizume, Kenichi; Iino, Yoshimi; Koizumi, Kiyoshi; Hotoda, Kentaro; Inoue, Shinya; Matayoshi, Hideki; Yoshitake, Akihiro; Yozu, Ryohei.

In: Japanese Journal of Thoracic and Cardiovascular Surgery, Vol. 51, No. 7, 07.2003, p. 302-307.

Research output: Contribution to journalArticle

Aeba, R, Katogi, T, Hashizume, K, Iino, Y, Koizumi, K, Hotoda, K, Inoue, S, Matayoshi, H, Yoshitake, A & Yozu, R 2003, 'The Limitation of Staged Repair in the Surgical Management of Congenital Complex Heart Anomalies with Aortic Arch Obstruction', Japanese Journal of Thoracic and Cardiovascular Surgery, vol. 51, no. 7, pp. 302-307.
Aeba, Ryo ; Katogi, Toshiyuki ; Hashizume, Kenichi ; Iino, Yoshimi ; Koizumi, Kiyoshi ; Hotoda, Kentaro ; Inoue, Shinya ; Matayoshi, Hideki ; Yoshitake, Akihiro ; Yozu, Ryohei. / The Limitation of Staged Repair in the Surgical Management of Congenital Complex Heart Anomalies with Aortic Arch Obstruction. In: Japanese Journal of Thoracic and Cardiovascular Surgery. 2003 ; Vol. 51, No. 7. pp. 302-307.
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abstract = "Objective: Severe aortic arch obstruction including an interrupted aortic arch in congenital complex heart anomalies remains a challenge in surgical management. Methods: Treatment and outcomes in 75 consecutive patients who underwent an aortic arch repair as the first step of the staged repair protocol between 1975 and 2000 were reviewed. Their ages at repair ranged from 1 day to 8.5 months. Results: Cross-sectional postoperative follow-up data were available in all the patients. The follow-up period ranged from 0 to 27.6 years (mean: 7.3 ± 7.3 years). There were 20 postoperative hospital deaths (27{\%}) and 7 late deaths. The Kaplan-Meier estimate of survival was 81.3{\%} ± 4.5{\%} at 1 month, 68.0{\%} ± 5.4{\%} at 1 year, 65.0{\%} ± 5.5{\%} at 5 years, 63.1{\%} ± 5.7{\%} at 10 years, 63.1{\%} ± 5.7{\%} at 20 years. By Cox regression analysis, body weight of 2.5 kg or less is the only independent determinant of postoperative mortality (p = 0.04, multivariable odds ratio: 2.50, [95{\%} confidence interval: 1.02-6.1]). The aortic arch morphology, the primary cardiac lesion, or date of operation did not reach a statistically significant level to show correlation with mortality. Reintervention to reconstruct the aortic arch was performed at 9 occasions in 8 of the 55 patients who survived the primary operation (14.5{\%}). The Kaplan-Meier estimate of the reintervention-free rate was 91.3{\%} ± 4.2{\%} at 5 years, 85.5{\%} ± 5.6{\%} at 10 years, 75.6{\%} ± 8.2{\%} at 20 years. Using multivariable Cox regression analysis, interrupted aortic arch (versus aortic coarctation) was the only independent predictor of a shorter time to reintervention (p = 0.001, multivariable odds ratio: 16.1, [95{\%} confidence interval: 3.2-80.2]). Conclusions: The staged repair protocol was associated with significant limitations in patient survival and with the development of recurrent aortic arch obstruction. Thus, a primary repair protocol may serve as an alternate approach, especially in patients with low weight or with an interrupted aortic arch.",
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T1 - The Limitation of Staged Repair in the Surgical Management of Congenital Complex Heart Anomalies with Aortic Arch Obstruction

AU - Aeba, Ryo

AU - Katogi, Toshiyuki

AU - Hashizume, Kenichi

AU - Iino, Yoshimi

AU - Koizumi, Kiyoshi

AU - Hotoda, Kentaro

AU - Inoue, Shinya

AU - Matayoshi, Hideki

AU - Yoshitake, Akihiro

AU - Yozu, Ryohei

PY - 2003/7

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N2 - Objective: Severe aortic arch obstruction including an interrupted aortic arch in congenital complex heart anomalies remains a challenge in surgical management. Methods: Treatment and outcomes in 75 consecutive patients who underwent an aortic arch repair as the first step of the staged repair protocol between 1975 and 2000 were reviewed. Their ages at repair ranged from 1 day to 8.5 months. Results: Cross-sectional postoperative follow-up data were available in all the patients. The follow-up period ranged from 0 to 27.6 years (mean: 7.3 ± 7.3 years). There were 20 postoperative hospital deaths (27%) and 7 late deaths. The Kaplan-Meier estimate of survival was 81.3% ± 4.5% at 1 month, 68.0% ± 5.4% at 1 year, 65.0% ± 5.5% at 5 years, 63.1% ± 5.7% at 10 years, 63.1% ± 5.7% at 20 years. By Cox regression analysis, body weight of 2.5 kg or less is the only independent determinant of postoperative mortality (p = 0.04, multivariable odds ratio: 2.50, [95% confidence interval: 1.02-6.1]). The aortic arch morphology, the primary cardiac lesion, or date of operation did not reach a statistically significant level to show correlation with mortality. Reintervention to reconstruct the aortic arch was performed at 9 occasions in 8 of the 55 patients who survived the primary operation (14.5%). The Kaplan-Meier estimate of the reintervention-free rate was 91.3% ± 4.2% at 5 years, 85.5% ± 5.6% at 10 years, 75.6% ± 8.2% at 20 years. Using multivariable Cox regression analysis, interrupted aortic arch (versus aortic coarctation) was the only independent predictor of a shorter time to reintervention (p = 0.001, multivariable odds ratio: 16.1, [95% confidence interval: 3.2-80.2]). Conclusions: The staged repair protocol was associated with significant limitations in patient survival and with the development of recurrent aortic arch obstruction. Thus, a primary repair protocol may serve as an alternate approach, especially in patients with low weight or with an interrupted aortic arch.

AB - Objective: Severe aortic arch obstruction including an interrupted aortic arch in congenital complex heart anomalies remains a challenge in surgical management. Methods: Treatment and outcomes in 75 consecutive patients who underwent an aortic arch repair as the first step of the staged repair protocol between 1975 and 2000 were reviewed. Their ages at repair ranged from 1 day to 8.5 months. Results: Cross-sectional postoperative follow-up data were available in all the patients. The follow-up period ranged from 0 to 27.6 years (mean: 7.3 ± 7.3 years). There were 20 postoperative hospital deaths (27%) and 7 late deaths. The Kaplan-Meier estimate of survival was 81.3% ± 4.5% at 1 month, 68.0% ± 5.4% at 1 year, 65.0% ± 5.5% at 5 years, 63.1% ± 5.7% at 10 years, 63.1% ± 5.7% at 20 years. By Cox regression analysis, body weight of 2.5 kg or less is the only independent determinant of postoperative mortality (p = 0.04, multivariable odds ratio: 2.50, [95% confidence interval: 1.02-6.1]). The aortic arch morphology, the primary cardiac lesion, or date of operation did not reach a statistically significant level to show correlation with mortality. Reintervention to reconstruct the aortic arch was performed at 9 occasions in 8 of the 55 patients who survived the primary operation (14.5%). The Kaplan-Meier estimate of the reintervention-free rate was 91.3% ± 4.2% at 5 years, 85.5% ± 5.6% at 10 years, 75.6% ± 8.2% at 20 years. Using multivariable Cox regression analysis, interrupted aortic arch (versus aortic coarctation) was the only independent predictor of a shorter time to reintervention (p = 0.001, multivariable odds ratio: 16.1, [95% confidence interval: 3.2-80.2]). Conclusions: The staged repair protocol was associated with significant limitations in patient survival and with the development of recurrent aortic arch obstruction. Thus, a primary repair protocol may serve as an alternate approach, especially in patients with low weight or with an interrupted aortic arch.

KW - Aortic arch obstruction

KW - Staged repair

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