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Clinical Outcomes and Echocardiographic Predictors of Reintervention After Interrupted Aortic Arch Repair

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Abstract

Left ventricular outflow tract obstruction (LVOTO) remains a significant complication after primary repair of interrupted aortic arch with ventricular septal defect (IAA-VSD). Clinical and echocardiographic predictors for LVOTO reoperation are controversial and procedures to prophylactically prevent future LVOTO are not reliable. However, it is important to identify the patients at risk for future LVOTO intervention after repair of IAA-VSD. Patients who underwent single-stage IAA-VSD repair at our center 2006–2021 were retrospectively reviewed, excluding patients with associated cardiac lesions. Two-dimensional measurements, LVOT gradients, and 4-chamber (4C) and short-axis (SAXM) strain were obtained from preoperative and predischarge echocardiograms. Univariate risk analysis for LVOTO reoperation was performed using unpaired t-test. Thirty patients were included with 21 (70%) IAA subtype B and mean weight at surgery 3.0 kg. Repair included aortic arch patch augmentation in 20 patients and subaortic obstruction intervention in three patients. Seven (23%) required reoperations for LVOTO. Patient characteristics were similar between patients who required LVOT reoperation and those who did not. Patch augmentation was not associated with LVOTO reintervention. Patients requiring reintervention had significantly smaller LVOT AP diameter preoperatively and at discharge, and higher LVOT velocity, smaller AV annular diameter, and ascending aortic diameter at discharge. There was an association between LVOT-indexed cross-sectional area (CSAcm2/BSAm2) ≤ 0.7 and reintervention. There was no significant difference in 4C or SAXM strain in patients requiring reintervention. LVOTO reoperation was not associated with preoperative clinical or surgical variables but was associated with smaller LVOT on preoperative echo and smaller LVOT, smaller AV annular diameter, and increased LVOT velocity at discharge.

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Abbreviations

AV:

Aortic valve

BSA:

Body surface area

CSA:

Cross-sectional area

DORV:

Double outlet right ventricle

IAA:

Interrupted aortic arch

LVOT(O):

Left ventricular outflow tract (obstruction)

PDA:

Patent ductus arteriosus

STE:

Speckle-tracking echocardiography

TGA:

Transposition of the great arteries

VSD:

Ventricular septal defect

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Stanford Health Care, Palo Alto, CA, USA

    Hannah L. McMullen

  2. Division of Pediatric Cardiology, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Jamie K. Harrington

  3. Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, Department of Surgery, Morgan Stanley Children Hospital-New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, CHN-274, New York, NY, 10032, USA

    David Blitzer, Emile Bacha & David Kalfa

  4. Division of Pediatric Cardiology, Morgan Stanley Children Hospital-New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, CHN-274, New York, NY, 10032, USA

    Nikhil Pasumarti & Stéphanie Levasseur

Authors
  1. Hannah L. McMullen
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  2. Jamie K. Harrington
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  3. David Blitzer
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  4. Nikhil Pasumarti
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  5. Stéphanie Levasseur
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  6. Emile Bacha
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  7. David Kalfa
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Contributions

HM and DB conceptualized the study and collected data. JH and NP reviewed echocardiographic studies and performed measurements. EB, DK, and SL assisted in development of measurement guidelines and criteria, as well as expert review and input critical for formation of the project. HM completed all analysis, wrote the main manuscript text, and prepared all tables and figure.

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Correspondence to David Kalfa.

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The authors declare no competing interests.

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McMullen, H.L., Harrington, J.K., Blitzer, D. et al. Clinical Outcomes and Echocardiographic Predictors of Reintervention After Interrupted Aortic Arch Repair. Pediatr Cardiol 45, 967–975 (2024). https://doi.org/10.1007/s00246-024-03419-7

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  • DOI: https://doi.org/10.1007/s00246-024-03419-7

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