@Article{chd.12599,
AUTHOR = {Ginnie Abarbanell, William L. Border, Brian Schlosser, Gemma Morrow, Michael Kelleman, Ritu Sachdeva},
TITLE = {Preoperative echocardiographic measures in interrupted aortic arch: Which ones best predict surgical approach and outcome?},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {3},
PAGES = {476--482},
URL = {http://www.techscience.com/schd/v13n3/39005},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> It is unclear whether neonates with interrupted aortic arch (IAA) and a smaller left ventricular outflow tract may have improved outcomes with a Yasui operation (ventricular outflow
bypass procedure) over a primary complete repair. This study sought to identify preoperative echocardiographic parameters to differentiate which neonates may have improved outcomes with a
primary vs Yasui operation.<br/>
<b>Design:</b> Patient demographics, cardiac surgery type, complications, need for reoperation and/or interventional catheterization, and date of last follow-up were collected on neonates who underwent a
biventricular repair for IAA from 2003 to 2014. Preoperative echocardiograms were analyzed for: IAA
type, valve annulus size, aortic valve morphology, ventricular size and aortic arch anatomy.<br/>
<b>Results:</b> Seventy-seven neonates underwent IAA repair between 2003 and 2013. 60 neonates
had a primary repair and 17 a Yasui operation. Neonates that underwent a Yasui operation had significantly smaller mitral and aortic valves with aortic arch hypoplasia. Within the primary repair
group, a decreasing aortic root z-score on univariate analysis increased the odds of reoperation by
twofold [OR = 1.98, 95% CI: (1.15-3.42), P = .014]. A significant interaction between repair type
and aortic root z-score was identified on multivariable analysis (P = .039), for neonates with aortic
root z-scores less than -2.5, the probability of reoperation during the follow up time period [mean
4.5 years (3.3 months-10 year)] was significantly higher in the primary repair group compared to
the Yasui group (64.3% vs 37.5%).<br/>
<b>Conclusions:</b> Neonates with IAA and an aortic root z-score less than -2.5 have lower odds of subsequent reoperations with a Yasui operation compared to a primary repair over the follow up
period. These findings suggest a Yasui operation should be considered if the preoperative aortic
root z-score is less than -2.5. Careful evaluation of these morphologic predictors on preoperative
echocardiograms can be helpful in surgical planning in neonates with IAA.},
DOI = {10.1111/chd.12599}
}