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

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.

Probability of Uneventful Recovery After Elective Aortic Root Replacement for Aortic Aneurysm.

BACKGROUND: Little is known about the chance of patients not experiencing complications (uneventful recovery) after aortic root replacement for aortic aneurysm. The aim of this study was to investigate the probability of uneventful recovery, identify its predictors, and address the association between the uneventful recovery and long-term survival. METHODS: Patients with aortic aneurysm who underwent elective aortic root replacement between 2005 and 2018 were retrospectively reviewed (N = 676). Uneventful recovery was defined as avoidance of all of the following complications during the index hospital stay (selected based on Cox proportional hazards regression for long-term survival): mortality, any stroke, reexploration for bleeding, respiratory failure, acute renal failure, deep sternal infection, and postcardiotomy shock. Permanent pacemaker implantation was included because of its clinical perspectives. Patients were divided into 4 different age groups (group <60 years of age, n = 299; group 60-69 years of age, n = 209; group 70-79 years of age, n = 125; group ≥80 years of age, n = 43), according to a restricted cubic spline analysis on in-hospital mortality and postoperative stroke. RESULTS: Uneventful recovery was 78.1%. The probability of uneventful recovery decreased in a linear fashion as the age increases (82.6% in the group <60 years of age, 79.0% in the group 60-69 years of age, 70.4% in the group 70-79 years of age, 65.1% in the group ≥80 years of age; P = .007). A multivariable logistic regression showed age, left ventricular ejection fraction, previous cardiac surgery, and peripheral artery disease were independent predictors of uneventful recovery. Uneventful recovery resulted in significantly better 5-year survival (log-rank P = .039). CONCLUSIONS: This study provides novel information regarding the probability of uneventful recovery while confirming low in-hospital mortality and stroke rates after elective aortic root replacement for aortic aneurysm. Importantly, uneventful recovery ensures excellent long-term survival.