Prognostic analysis of one-stage radical resection of interruption of aortic arch combined with ventricular septal defect in infants

Abstract

Background: To analyze the risk factors of death and aortic stenosis (AS) in infants with interruption of aortic arch (IAA) combined with ventricular septal defect (VSD).Methods: A retrospective analysis was performed on 152 children with IAA combined with VSD who were admitted to our hospital from January 2006 to January 2022, including 85 cases of type A, 57 cases of type B and 10 cases of type C, and who had undergone one-stage radical surgery. Cox proportional hazards regression model was used to analyze the risk factors of death and AS after one-stage radical resection. Kaplan-Meier method was used to analyze postoperative overall survival rate, and R software was used to draw survival curve. Results: Of all patients, 22 cases (14.47%) died after surgery, and 27 cases (17.76%) experienced AS. The 1-month, 3-month, 6-month, 1-year, 2-year, 3-year, 4-year, and 5-year survival rates were 94.06%, 94.06%, 90.10%, 88.12%, 86.80%, 86.14%, 86.14% and 85.48%, respectively.Low body weight (P=0.004), large ratio of VSD diameter/diameter of aortic root (VSD/AO) (P=0.008), long duration of cardiopulmonary bypass (P=0.002), long hypothermic circulatory arrest (P=0.036), the period of surgery (from January 2006 to December 2013) (P= 0.038), and left ventricular outflow tract (LVOT) obstruction (P=0.000) were related risk factors for postoperative mortality. Of these, low body weight ( P = 0.004 ), large ratio of VSD/AO ( P = 0.044 ), long duration of cardiopulmonary bypass (P = 0.044), and combined LVOT (P = 0.000) were independent risk factors for postoperative mortality. The time of surgery (from January 2006 to December 2013) (P=0.046), and the addition of anastomosis with autologous pericardium to the anterior aortic wall (P=0.015) were associated risk factors for postoperative AS, and the latter (P=0.021) was the independent risk factor for postoperative AS. Conclusions: The mortality and AS rate are still high in infants with IAA and VSD after one-stage radical surgery. Patients with low body weight, large ratio of VSD/AO, long duration of cardiopulmonary bypass, LVOT and anastomosis with autologous pericardium to the anterior aortic wall have poor prognosis.