Aortic reoperation in adults with corrected Conotruncal defects

Introduction: Increasing survival of children with corrected congenital heart defects presents challenges to adult congenital cardiac surgeons. Conotruncal defects are a subtype of complex congenital heart disease affecting the left and right ventricular outflow tracts. In adulthood, the development of aortic aneurysms and aortic valve regurgitation necessitates complex aortic surgical reintervention. Methods: A retrospective review was performed of adult patients undergoing aortic surgery with a history of corrected conotruncal defects from two University affiliated hospitals in Victoria, Australia. Results: From April 2003 to December 2014, 16 patients mean age 32.7 + 12.6 years underwent surgical reintervention. 12(75%) were male. Original diagnoses: Tetralogy of Fallot 7(43.8%), TGA post switch 4(25.0%), truncus arteriosus 3(18.8%), Interrupted Arch 1(6.3%) and Double outlet right ventricle 1(6.3%). All patients had Aortic root enlargement, mean diameter 59mm(45-84mm). Significant aortic regurgitation was present in 13, Aortic Stenosis in 1, mixed aortic valve disease in 1. Operation(s) performed: Aortic root replacement with a composite valve/graft conduit 14 (87.5%), Ross procedure 1 (6.3%), aortic valve replacement/ascending tube 1(6.3%). Two (12.5%) patients had concomitant pulmonary valve replacement, and 3(18.8%) underwent concomitant RVto PAconduit replacement. There were no perioperative or late deaths. One (6.3%) patient returned to theatre for bleeding, 2(12.5%) had new onset renal failure not requiring haemofiltration, 3(18.8%) patients required inotropes for low cardiac output and 3(18.8%) for low systemic vascular resistance. No patients required an IABP or experienced arrhythmias. Conclusion: Aortic reoperation for patients with late complications of corrected conotruncal anomalies can be performed safely with minimal perioperative morbidity.