Abstract

Objective: Surgical correction of Aortopulmonary Window (APW) remains challenging due to its rarity and frequent association with other congenital anomalies. This study reviews outcomes and identifies prognostic factors following APW repair over a 12-year period at Vietnam National Children’s Hospital.

Methods: We retrospectively analyzed 61 patients who underwent APW repair between 2012 and 2024.

Results: Median age at surgery was 70 days (range from 37-141 days). Preoperative conditions included pulmonary hypertension (90.2%), malnutrition (72.1%), and infection (18%). APW types were distributed evenly (Type 1: 36%, Type 2: 28%, Type 3: 36%). Associated anomalies included interrupted aortic arch (IAA, 26.2%), aortic arch hypoplasia (4.9%), and ASD (13,1%). Surgical methods included sandwich technique (75.4%), resection and suturing (21.3%), and ligation (3.3%). The 30-day and long-term survival rates were 88.5%, with all deaths occurring during the hospital stay. No late mortality was observed. The 8-year survival rate was 88.5% (95% CI: 80.9–96.9%). ECMO was used in 4 patients. Prolonged mechanical ventilation emerged as the strongest independent predictor of mortality (AUC 0.952). Freedom from reoperation/reintervention was 79% at the latest follow-up. No specific correlation was found between surgical technique, APW type, or arch reconstruction and need for reintervention. However, pairwise comparison showed a statistically significant difference between Type 2 and Type 3 (p = 0.045). Logistic regression models did not identify reliable predictors for reintervention.

Conclusions: Surgical outcomes for APW repair are favorable, with excellent long-term survival. Postoperative mechanical ventilation duration is a key predictor of mortality. Despite the complexity of associated anomalies, surgical technique and APW type were not independently associated with mortality or reintervention, highlighting the importance of perioperative management in optimizing outcomes.