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This study assessed the long-term outcomes of patients with vascular ring division.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A multi-institution retrospective review of 371 patients with vascular rings undergoing surgical division at 3 paediatric cardiac institutions between November 2007 and October 2019 was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The complete vascular rings consisted of a double aortic arch (24.5%), right aortic arch with left ligamentum arteriosum (36.7%) and left aortic arch, with right ligamentum arteriosum (0.5%). The incomplete vascular rings consisted of a pulmonary artery sling (22.9%), left aortic arch with aberrant right subclavian artery (15.1%) and innominate artery compression syndrome (0.3%). Respiratory symptoms included stridor (71.4%), wheezing (49.1%), coughing (31.5%), gastrointestinal symptoms included choking (12.4%), dysphagia (3.2%) and emesis (1.9%). Only one patient died after discharge, yielding a late mortality rate of 0.3% (1\/360). The 10-year overall survival rate was 96.8%. Postoperative complications were reported in 51 patients, 15 of whom required reoperation. The 10-year freedom from reoperation rate was 95.9%. Follow-up was completed in 95.4% (354\/371) of patients, with a mean follow-up time of 4.3\u2009\u00b1\u20092.9\u2009years (range from 1 to 13\u2009years). Twenty patients (5.6%) experienced residual symptoms during long-term follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The outcomes of vascular ring division are excellent. A Kommerell diverticulum &amp;gt;1.5 times the aberrant left subclavian artery origin is an operative indication for primary resection. Tracheomalacia is a risk factor for reoperation and residual symptoms, and preoperative fibrobronchoscopy is important for evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezab432","type":"journal-article","created":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T09:08:38Z","timestamp":1632474518000},"page":"605-613","source":"Crossref","is-referenced-by-count":32,"title":["Long-term outcomes in children undergoing vascular ring division: a multi-institution experience"],"prefix":"10.1093","volume":"61","author":[{"given":"Di","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Children\u2019s Hospital of Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhangke","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Beijing Children\u2019s Hospital, Capital Medical University, National Center for Children\u2019s Health, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"You","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Children\u2019s Hospital of Suqian, Suqian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Children\u2019s Hospital of Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jirong","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Children\u2019s Hospital of Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Children\u2019s Hospital of Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaihong","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Children\u2019s Hospital of Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofeng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Beijing Children\u2019s Hospital, Capital Medical University, National Center for Children\u2019s Health, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuming","family":"Mo","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Children\u2019s Hospital of Nanjing Medical University, Nanjing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,10,11]]},"reference":[{"key":"2022022016290549300_ezab432-B1","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1056\/NEJM194511152332003","article-title":"Surgical relief for tracheal obstruction from a vascular ring","volume":"233","author":"Gross","year":"1945","journal-title":"N Engl J Med"},{"key":"2022022016290549300_ezab432-B2","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1016\/j.jtcvs.2004.10.044","article-title":"Trends in vascular ring surgery","volume":"129","author":"Backer","year":"2005","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2022022016290549300_ezab432-B3","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/j.jpedsurg.2009.12.013","article-title":"Multidetector computed tomography and 3-dimensional imaging: preoperative evaluation of thoracic vascular and tracheobronchial anomalies and abnormalities in pediatric patients","volume":"45","author":"Lee","year":"2010","journal-title":"J Pediatr Surg"},{"key":"2022022016290549300_ezab432-B4","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1016\/j.jtcvs.2004.08.030","article-title":"Preoperative and postoperative evaluation of airways compression in pediatric patients with 3-dimensional multislice computed tomographic scanning: effect on surgical management","volume":"129","author":"Lambert","year":"2005","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2022022016290549300_ezab432-B5","doi-asserted-by":"crossref","first-page":"S308","DOI":"10.1016\/S0003-4975(99)01279-5","article-title":"Congenital Heart Surgery Nomenclature and Database Project: vascular rings, tracheal stenosis, pectus excavatum","volume":"69","author":"Backer","year":"2000","journal-title":"Ann Thorac Surg"},{"key":"2022022016290549300_ezab432-B6","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1007\/s00595-019-01907-5","article-title":"Congenital vascular ring","volume":"50","author":"Yoshimura","year":"2020","journal-title":"Surg Today"},{"key":"2022022016290549300_ezab432-B7","first-page":"350","article-title":"Acquired tracheobronchomalacia. 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