Long-term outcomes in children undergoing vascular ring division: a multi-institution experience
Open Access
- 11 October 2021
- journal article
- research article
- Published by Oxford University Press (OUP) in European Journal of Cardio-Thoracic Surgery
- Vol. 61 (3), 605-613
- https://doi.org/10.1093/ejcts/ezab432
Abstract
Vascular rings are rare anomalies of congenital heart disease that cause respiratory and gastrointestinal symptoms. This study assessed the long-term outcomes of patients with vascular ring division. 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. 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 ± 2.9 years (range from 1 to 13 years). Twenty patients (5.6%) experienced residual symptoms during long-term follow-up. The outcomes of vascular ring division are excellent. A Kommerell diverticulum >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.Funding Information
- National Key Research and Development Program of China (2017YFC1308105, 2016YFC1101001)
- Clinical Frontier Technology of Clinical Medicine of Jiangsu Provincial Science and Technology Department (BE2017608)
- National Natural Science Foundation of China (81700288, 81970265)
This publication has 23 references indexed in Scilit:
- Bioresorbable Airway Splint Created with a Three-Dimensional PrinterThe New England Journal of Medicine, 2013
- Primary Translocation of Aberrant Left Subclavian Artery for Children With Symptomatic Vascular RingThe Annals of Thoracic Surgery, 2012
- Multidetector computed tomography and 3-dimensional imaging: preoperative evaluation of thoracic vascular and tracheobronchial anomalies and abnormalities in pediatric patientsJournal of Pediatric Surgery, 2010
- Follow-up of surgical correction of aortic arch anomalies causing tracheoesophageal compression: a 38-year single institution experienceJournal of Pediatric Surgery, 2009
- Management and Outcomes of Double Aortic Arch in 81 PatientsPEDIATRICS, 2006
- Trends in vascular ring surgeryThe Journal of Thoracic and Cardiovascular Surgery, 2005
- Diverticula of Kommerell and Aberrant Subclavian Arteries Complicated by AneurysmsCardioVascular and Interventional Radiology, 2005
- Preoperative and postoperative evaluation of airways compression in pediatric patients with 3-dimensional multislice computed tomographic scanning: Effect on surgical managementThe Journal of Thoracic and Cardiovascular Surgery, 2005
- Congenital Heart Surgery Nomenclature and Database Project: vascular rings, tracheal stenosis, pectus excavatumThe Annals of Thoracic Surgery, 2000
- Surgical Relief for Tracheal Obstruction from a Vascular RingThe New England Journal of Medicine, 1945