Prognosis Analysis of Children with Interrupted Aortic Arch Complicated with Ventricular Septal Defect and Other Associated Intracardiac Defects after One-Stage Radical Surgery

Background: High rates of mortality and aortic arch steno-sis have been reported for one-stage radical surgery of in-terruption of aortic arch (IAA) with ventricular septal de-fect (VSD) and other associated intracardiac defects, but the sample size of the study is relatively small, and the credi-bility of the study is not high. The risk factors of death and aortic arch stenosis will be analyzed in a large sample size of infants with IAA, VSD and other associated intracardiac defects after one-stage radical resection. Methods: A retro-spective analysis was performed on 152 children with IAA, VSD and other associated intracardiac defects from January 2006 to January 2017 who had undergone one-stage rad-ical resection, including 95 cases of type A and 57 cases of type B. January 2006-December 2011 as the early pe-riod, and January 2012-January 2017 as the late period. Cox proportional hazards regression model was used to an-alyze the risk factors for mortality and aortic arch stenosis after surgery, the overall survival rate was analyzed by the Kaplan-Meier method, and the survival curve was drawn by GraphPad Prism 8 software. Results: 22 cases (14.47%) died, 27 cases (17.76%) developed aortic arch stenosis. The 1-month, 3-month, 6-month, 1-year, 3-year, and 5-year sur-vival rates were 85.53%, 85.53%, 85.53%, 84.21%, 78.95% and 75.66%, respectively. Low age (Hazard Ratio (HR) = 0.551, 95% Confidence Interval (CI): 0.320-0.984, p = 0.004), low body weight (HR = 0.632, 95% CI: 0.313- 0.966, p = 0.003), large ratio of VSD diameter/aortic di-ameter (VSD/AO) (HR = 2.547, 95% CI: 1.095-7.517, p = 0.044), long duration of cardiopulmonary bypass (HR = 1.374, 95% CI: 1.000-3.227, p = 0.038), and left ven-tricular outflow tract obstruction (LVOTO) (HR = 3.959, 95% CI: 1.123-9.268, p = 0.015) were independent risk factors for postoperative death. The surgical period (Jan-uary 2006-December 2011) (HR = 0.439, 95% CI: 0.109- 0.964, p = 0.046) and the addition of pericardial anastomo-sis to the anterior aortic wall (HR = 0.398, 95% CI: 0.182- 0.870, p = 0.021) were independent risk factors for post-operative aortic arch stenosis. Conclusions: Children with low age, low body weight, large ratio of VSD/AO, long du-ration of cardiopulmonary bypass, LVOTO, the surgical pe-riod (January 2006-December 2011) and pericardial anas-tomosis with anterior aortic wall have poor prognosis.