1997 OPEN FORUM Abstracts
RESPIRATORY COMPLICATIONS AFTER EXTENDED DIRECT ANASTOMOSIS FOR NEONATAL AORTIC ARCH ANOMALY.
Muneyuki Takeuchi, MD, Hideaki Imanaka, MD, Naoki Yahagi, MD, Yasuhiko Watanabe, MD, Keiji Kumon, MD. Department of Surgical Intensive Care Unit, National Cardiovascular Center, Osaka, Japan
Respiratory complications are common after extended direct anastomosis for neonatal aortic arch anomaly. However, there has been no report about the incidence. The purpose of this study is to evaluate the incidence and prognosis in such patients. SUBJECTS AND Methods: Subjects were 31 consecutive neonates (age < 28 days) who underwent extended direct anastomosis for neonatal aortic arch anomaly (18 with coarctation of the aorta and 13 with interruption of aortic arch) in our institute from 1992 to 1996. By a retrospective chart review, we investigated respiratory complications, prognosis, preoperative and postoperative ventilatory support. Results: Age and weight were 11.8±6.9 (mean±SD) days and 2.82±0.49 kg at the repair surgery, respectively. The mortality in ICU was 29% and that in hospital was 32%. Twelve neonates (39%) had required mechanical ventilation before the surgery because of congestive heart failure or deteriorating acidosis. The neonates who required mechanical ventilation before surgery showed significantly higher mortality than those who did not (58% vs 11%, p < 0.05). Twenty-four patients (77%) had postoperative respiratory complications; atelectasis (n=13), pneumothorax (n=8), pleural effusion (n=7), stenosis of the left main bronchus (n=6), phrenic nerve palsy (n=5), airway bleeding (n=4), and chylothorax (n=3). Postoperative intubation period was longer in patients with respiratory complications than in those without (37±54 vs 9 ±9 days, p < 0.05). CONCLUSION: Respiratory complications were common in neonates with aortic arch anomaly after extended direct anastomosis. The patients who developed respiratory complications needed longer ventilatory support.