Clinical Outcomes And Echocardiographic Predictors Of Reintervention After Interrupted Aortic Arch Repair
Hannah L. McMullen, MD, Jamie K. Harrington, MD, David Blitzer, MD, Nikhil Pasumarti, RDCS, Stéphanie Levasseur, MD, Emile Bacha, MD, David Kalfa, MD, PhD.
Morgan Stanley Children Hospital -New York Presbyterian Hospital, Columbia University, New York, NY, USA.
LVOTO remains a significant complication after primary repair of IAA-VSD, leading to increased risk of reoperation. Clinical and echocardiographic predictors for LVOTO reoperation are controversial and could guide decision-making for optimal initial surgery as well as identify at-risk patients prior to discharge. Methods:
Patients who underwent single-stage IAA-VSD repair at our center from 2006-2021 were retrospectively reviewed. We excluded patients with associated cardiac lesions. Two-dimensional measurements, LVOT gradients, and 4-chamber(4C) strain were obtained from pre-operative and pre-discharge echocardiograms. Univariate risk analysis for LVOTO reoperation was performed using paired t-test. Results:
30 patients were included: 21(70%) with IAA subtype B and mean weight at surgery 3.0kg. Repair included aortic arch patch augmentation in 20 and subaortic obstruction intervention in 3. 7(23%) required reoperations for LVOTO. Patient characteristics were similar between the groups. Patch augmentation was not associated with LVOTO reintervention. Patients requiring reintervention had smaller LVOT AP diameter, both preoperatively and pre-discharge. Patients requiring reintervention had pre-discharge higher LVOT velocity, smaller AV annular diameter, and smaller ascending aortic diameter. There was an association between LVOT indexed cross-sectional-area(CSAcm2/BSAm2)</=0.7 and increased risk of LVOTO reintervention. There was no significant difference in 4C strain. Conclusions:
LVOTO reoperation was not associated with preoperative clinical or surgical variables. LVOTO reoperation was associated with smaller LVOT on preoperative echo and smaller LVOT, smaller AV annular diameter and increased LVOT velocity pre-discharge.
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