Contemporary surgical outcome and symptomatic relief following vascular ring surgery in children: effect of prenatal diagnosis

Parinita Swarnkar, Simone Speggiorin, B. Conal Austin, Andrew Nyman, Caner Salih, Vita Zidere, John M. Simpson, Trisha V. Vigneswaran

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

OBJECTIVES: Our goal was to describe postoperative complications and outcomes in a large contemporary cohort of children with an isolated double aortic arch (DAA) or a right aortic arch (RAA) with left arterial ligament and to assess the impact of foetal diagnosis on outcomes. METHODS: We performed a retrospective analysis of all patients who underwent surgery for DAA or RAA with left arterial ligament between 2005 and 2019. RESULTS: A total of 132 children were operated on for a DAA (n = 77) or a RAA (n = 55). Prenatal diagnosis was made in 100/132 (75.8%). Median age at surgery for DAA was 5.0 (1.7-13.3) months and for RAA was 13.9 (6.4-20.1) months. There was no difference in the age at surgery between the prenatal and postnatal cases (8.6 [4.0-15.6] vs 5.4 months [1.8-17.7]; P = 0.37). No surgical deaths occurred. Vocal cord palsy was the most common complication, occurring in 12/132 (9%): of these, 11 resolved spontaneously and 1 required a temporary tracheostomy. Logistic regression demonstrated that older age at operation was the only predictor for a postoperative complication (P = 0.02). Overall, 21/67 (31%) of prenatally detected, symptomatic cases reported residual symptoms/signs 1 year after surgery compared to 18/28 (64%) of postnatally detected cases. Postnatal diagnosis was associated with persistent postoperative symptoms/signs [P = 0.006, odds ratio = 3.9 (95% confidence interval 1.5-9.4)]. CONCLUSIONS: Surgery to relieve a vascular ring resolves trache-oesophageal compressive symptoms in most cases, but parents/patients should be aware that symptoms/signs may persist in the first postoperative year despite effective release of the vascular ring. Earlier surgery and prenatal diagnosis may improve outcomes.

Original languageEnglish
Pages (from-to)1260-1268
Number of pages9
JournalEuropean Journal of Cardio-thoracic Surgery
Volume61
Issue number6
DOIs
Publication statusPublished - 27 May 2022
Externally publishedYes

Bibliographical note

Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Keywords

  • Cardiac surgery
  • Congenital heart disease
  • Double aortic arch
  • Prenatal diagnosis
  • Right aortic arch
  • vascular ring

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