Objectives. Biventricular repair of the interrupted aortic arch (IAA) in neonates involves an early choice between a single or two-stage strategy, with the risk factors for each not yet fully investigated. We assessed outcome of a selective single stage strategy at our institution.
Methods. A retrospective review to assess the outcome of neonates undergoing repair of IAA repair and associated congenital heart defects between 2000 and 2006. Pre-operative assessment, operative management and outcome were examined.
Results. Eighteen consecutive patients were identified. Associated congenital cardiac defects included VSD (17), truncus arteriosus (3), AP window (2), aortic valve atresia (2) and TGA (1). Seventeen underwent a single stage procedure including 2 Norwood-Rastelli and one arterial switch and IAA repair. The other patient, born at 32 weeks gestation weighing 970g underwent a two stage procedure with aortic arch repair and pulmonary artery banding at 3 weeks of age. There were no early deaths. One patient required a pacemaker for complete heart block. There are no late deaths and there was normal functional status with mean follow-up 4.5 years. The premature infant having a staged repair required a redo arch repair at the time of VSD closure. Three others required late reoperation, one Ross-Konno at 6 months and two pulmonary conduit changes both at 35 months.
Conclusions. Good functional status and low re-operation rates can be achieved with a single stage repair however an individualised approach is necessary for neonates with risk factors including low birth weight and prematurity.