This may facilitate better selection of candidates, as there may be some patients who will benefit from a univentricular physiology and who could not otherwise have been identified, which is especially important in the case of impaired left ventricular function.Ī study by the Congenital Heart Surgeons’ Society Data Center (Toronto) showed that primary biventricular repair in neonates in cases of critical aortic stenosis led to a high reintervention rate (50% at 3 years). The Norwood technique 2 avoids the initial complexity of corrective surgery, involves 2 normal ventricles contributing to cardiac output, and allows a period of growth prior to final biventricular correction. Yasui surgery 1 (a high-risk procedure for neonates, who are occasionally underweight), avoids provisional univentricular physiology and allows complete correction. Primary correction and 2-stage surgery are 2 options with very similar results for biventricular correction in this context, 3,4 representing a safe and effective strategy with excellent medium-term survival, although with a high rate of reintervention/interventionism. Overall survival during follow-up (n = 20) was 95% at 10 years. The incidence of reinterventions and interventionism in each group according to the surgical technique used is shown in the Table. Of the initial survivors (n = 20) 95%, 85%, 50% and 35% had not required reintervention after 1, 2, 5, and 10 years, and 70%, 65%, and 55% were without percutaneous procedures after 1, 2, and 5 years. Of the 20 survivors, 9 (45%) required intervention (arch stenosis or recoarctation in 5, and conduit stenosis in 9), and 9 underwent surgery again for conduit replacement (pacemaker implantation in 1 patient after obstructive resection of the left outflow tract). Mortality during follow-up (mean, 8.4 years) was 10.5% (n = 2, both following primary correction: sudden death of undetermined origin, episodes of ventricular tachycardia, and irreversible cardiac arrest). There were no deaths between the stages of the 2-stage approach. The remaining causes of early death were of non-cardiac origin. Overall 30-day mortality was 25.9% (n = 7), and operative mortality was 7.4% (n = 2, both following Yasui 1 surgery with failure of extracorporeal circulation during the interval before the implantation of a longer-term circulatory support technique). 05 was considered statistically significant. The Kaplan-Meier (log-rank test) was used for the survival analysis.
#SCREENING RECOMMENDATIONS FOR INTERRUPTED AORTIC ARCH SOFTWARE#
The analysis was performed using R software v3.0.2 (R Foundation for Statistical Computing, Vienna, Austria). The staged approach was implemented as standard in 2008.ĭata were extracted from our database (HeartSuite, Systeria, Inc, Glasgow, United Kingdom) and from medical records. Between 19, 27 patients (mean age, 19 days mean weight, 3.25 kg) with this diagnosis (aortic valve atresia in 18 and severe hypoplasia in 9, defined as ring diameter -2, left ventricle quotient (long axis) > 0.8, left ventricle ≥ 20 mL/m 2 and nonrestrictive ventricular septal defect.
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