{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:50:16Z","timestamp":1753876216104,"version":"3.41.2"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T00:00:00Z","timestamp":1717027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Canadian Institute of Health Research Vanier Award"},{"name":"University of Toronto Surgeon-Scientist Training Program Funding"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Left ventricular outflow tract obstruction (LVOTO) is a major cause of morbidity and mortality in infants with interrupted aortic arch (IAA). Left Ventricular Outflow Tract (LVOT) development may be flow-mediated, thus IAA morphology may influence LVOT diameter and subsequent reintervention. We investigated the association of IAA morphology [type and presence of aortic arch aberrancy (AAb)] with LVOT diameter and reintervention.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>All surgical patients with IAA (2001\u20132022) were reviewed at a single institution. We compared IAA-A versus IAA-B; IAA with aortic AAb versus none; IAA-B with aberrant subclavian (AAbS) artery versus others. Primary outcomes included LVOT diameter (mm), LVOTO at discharge (\u226550 mmHg), and LVOT reintervention.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Seventy-seven infants (mean age 10\u2009\u00b1\u200919\u2009days) were followed for 7.6 (5.5\u20139.7) years. Perioperative mortality was 3.9% (3\/77) and long-term mortality was 5.2% (4\/77). Out of 51 IAA-B (66%) and 22 IAA-A (31%) patients, 30% (n\u2009=\u200922) had AAb. Smaller LVOT diameter was associated with IAA-B [IAA-A: 5.40 (4.68\u20135.80), IAA-B: 4.60 (3.92\u20135.50), P\u2009=\u20090.007], AAb [AAb: 4.00 (3.70\u20135.04) versus none: 5.15 (4.30\u20135.68), P\u2009=\u20090.006], and combined IAA-B + AAbS [IAA-B + AAbS: 4.00 (3.70\u20135.02) versus other: 5.00 (4.30\u20135.68), P\u2009=\u20090.002]. The likelihood of LVOTO was higher among AAb [N\u2009=\u20096 (25%) vs N\u2009=\u20091 (2%), P\u2009=\u20090.004] and IAA-B + AAbS [N\u2009=\u20091 (2%) vs N\u2009=\u20096 (30%), P\u2009=\u20090.002]. Time-to-event analysis showed a signal towards increased LVOT reintervention in IAA-B + AAbS (P\u2009=\u20090.11).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>IAA-B and AAb are associated with small LVOT diameter and early LVOTO, especially in combination. This may reflect lower flow in the proximal arch during development. Most reinterventions occur in IAA-B + AAbS, hence these patients should be carefully considered for LVOT intervention at the time of initial repair.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezae220","type":"journal-article","created":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T21:46:26Z","timestamp":1717019186000},"source":"Crossref","is-referenced-by-count":0,"title":["Association of left ventricular outflow tract size with arch morphology in interrupted aortic arch"],"prefix":"10.1093","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4636-549X","authenticated-orcid":false,"given":"Malak","family":"Elbatarny","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Surgery, The Hospital for Sick Children , Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5062-6461","authenticated-orcid":false,"given":"Grace","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, University of Toronto School of Medicine , Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2798-3831","authenticated-orcid":false,"given":"Alison","family":"Howell","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, The Hospital for Sick Children , Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marisa","family":"Signorile","sequence":"additional","affiliation":[{"name":"Ted Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network , Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6373-0532","authenticated-orcid":false,"given":"Osami","family":"Honjo","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, The Hospital for Sick Children , Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3671-5337","authenticated-orcid":false,"given":"David J","family":"Barron","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, The Hospital for Sick Children , Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,5,30]]},"reference":[{"key":"2024060920401413300_ezae220-B1","article-title":"Interrupted aortic arch","author":"Alcantara","year":"2023","journal-title":"StatPearls"},{"key":"2024060920401413300_ezae220-B2","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/j.jtcvs.2010.07.067","article-title":"Persistent risk of subsequent procedures and mortality in patients after interrupted aortic arch repair: a Congenital Heart Surgeons\u2019 Society study","volume":"140","author":"Jegatheeswaran","year":"2010","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024060920401413300_ezae220-B3","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1007\/s00246-021-02689-9","article-title":"Predictors of left ventricular outflow tract obstruction after primary interrupted aortic arch repair","volume":"42","author":"Korsuize","year":"2021","journal-title":"Pediatr Cardiol"},{"key":"2024060920401413300_ezae220-B4","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1017\/S104795111700018X","article-title":"Growth of left ventricular outflow tract and predictors of future re-intervention after repair for ventricular septal defect and aortic arch obstruction","volume":"27","author":"Jijeh","year":"2017","journal-title":"Cardiol Young"},{"key":"2024060920401413300_ezae220-B5","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1016\/0735-1097(93)90785-Y","article-title":"Echocardiographic predictors of left ventricular outflow tract obstruction after repair of interrupted aortic arch","volume":"22","author":"Geva","year":"1993","journal-title":"J Am Coll Cardiol"},{"key":"2024060920401413300_ezae220-B6","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1111\/chd.12599","article-title":"Preoperative echocardiographic measures in interrupted aortic arch: which ones best predict surgical approach and outcome?","volume":"13","author":"Abarbanell","year":"2018","journal-title":"Congenit Heart Dis"},{"key":"2024060920401413300_ezae220-B7","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.athoracsur.2013.04.027","article-title":"Predictors of reintervention after repair of interrupted aortic arch with ventricular septal defect","volume":"96","author":"Chen","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2024060920401413300_ezae220-B8","first-page":"154","article-title":"Flow-mediated factors in the pathogenesis of hypoplastic left heart syndrome","volume":"9","author":"Rahman","year":"2022","journal-title":"J Cardiovasc Dev Dis"},{"key":"2024060920401413300_ezae220-B9","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1097\/MCC.0000000000000304","article-title":"Left ventricular outflow tract obstruction in ICU patients","volume":"22","author":"Slama","year":"2016","journal-title":"Curr Opin Crit Care"},{"key":"2024060920401413300_ezae220-B10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2261-14-147","article-title":"Prevalence, associated factors and management implications of left ventricular outflow tract obstruction in takotsubo cardiomyopathy: a two-year, two-center experience","volume":"14","author":"Backer","year":"2014","journal-title":"BMC Cardiovasc Disord"},{"key":"2024060920401413300_ezae220-B11","doi-asserted-by":"crossref","first-page":"S43","DOI":"10.1016\/j.jacc.2011.04.046","article-title":"Left ventricular hypoplasia: a spectrum of disease involving the left ventricular outflow tract, aortic valve, and aorta","volume":"59","author":"Hickey","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"2024060920401413300_ezae220-B12","doi-asserted-by":"crossref","first-page":"e166","DOI":"10.1093\/ejcts\/ezt658","article-title":"The yasui operation for patients with adequate-sized ventricles and ventricular septal defect associated with obstructions of the aortic arch and left ventricular outflow tract","volume":"45","author":"Nakano","year":"2014","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024060920401413300_ezae220-B13","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.athoracsur.2010.04.065","article-title":"Impact of aortic annular size on rate of reoperation for left ventricular outflow tract obstruction after repair of interrupted aortic arch and ventricular septal defect","volume":"90","author":"Hirata","year":"2010","journal-title":"Ann Thorac Surg"},{"key":"2024060920401413300_ezae220-B14","first-page":"187","article-title":"Hard choices for high-risk patients with critical left ventricular outflow obstruction","author":"Pizarro","year":"2010"},{"key":"2024060920401413300_ezae220-B15","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ijcard.2021.08.017","article-title":"The clinical presentation and outcome of aortic coarctation associated with left ventricular inflow and outflow tract lesion in adult patients: shone syndrome and beyond","volume":"343","author":"Khan","year":"2021","journal-title":"Int J Cardiol"},{"key":"2024060920401413300_ezae220-B16","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/S0022-5223(96)70444-0","article-title":"One-stage repair of interrupted aortic arch, ventricular septal defect, and subaortic obstruction in the neonate: a novel approach","volume":"111","author":"Luciani","year":"1996","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024060920401413300_ezae220-B17","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1016\/j.jtcvs.2012.07.060","article-title":"Aortic valve replacement in neonates and infants: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database","volume":"144","author":"Woods","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024060920401413300_ezae220-B18","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1053\/j.pcsu.2019.02.004","article-title":"How small is too small? Decision-making and management of the small aortic root in the setting of interrupted aortic arch","volume":"22","author":"Riggs","year":"2019","journal-title":"Semin Thorac Cardiovasc Surg Pediatric Cardiac Surg Annu"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezae220\/58011014\/ezae220.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/65\/6\/ezae220\/58178459\/ezae220.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/65\/6\/ezae220\/58178459\/ezae220.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,9]],"date-time":"2024-06-09T20:40:37Z","timestamp":1717965637000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezae220\/7685388"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,30]]},"references-count":18,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,6,3]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezae220","relation":{},"ISSN":["1873-734X"],"issn-type":[{"type":"electronic","value":"1873-734X"}],"subject":[],"published-other":{"date-parts":[[2024,6]]},"published":{"date-parts":[[2024,5,30]]},"article-number":"ezae220"}}