Original Articles
Repair of coarctation with resection and extended end-to-end anastomosis

Presented at the Poster Session of the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.
https://doi.org/10.1016/S0003-4975(98)00671-7Get rights and content

Abstract

Background. Our surgical strategy for infant coarctation changed from subclavian flap aortoplasty to resection with extended end-to-end anastomosis in 1991. The purpose of this review was to evaluate the results of that strategy.

Methods. From 1991 through 1997, 55 infants underwent repair of coarctation of the aorta using resection with extended end-to-end anastomosis. Isolated coarctation of the aorta was present in 26 patients, 20 patients had a ventricular septal defect, and 9 patients had other associated intracardiac lesions. Mean age at surgery was 0.20 ± 0.24 years (median, 21 days). In 34 patients (62%), arch reconstruction was performed through a left thoracotomy. Twenty patients (36%) had median sternotomy with simultaneous repair of coarctation of the aorta and intracardiac repair of associated lesions. One patient had recoarctation repair through a median sternotomy. All coarctation and ductal tissue was resected and the anastomosis was constructed starting opposite the left carotid artery with running polypropylene suture.

Results. There was one early death 26 days after coarctation of the aorta and ventricular septal defect repair in a child on extracorporeal membrane oxygenation for meconium aspiration and 2 late deaths owing to pneumonia and pulmonary hypertension (1) and interventricular hemorrhage (1). There were no instances of paraplegia. Follow-up in survivors ranges from 10 to 76 months (mean, 39.8 ± 17.2 months). Recoarctation has developed in 2 patients, who have had successful balloon dilation 6 and 14 months after the operation. This yields a low recoarctation rate of 3.6%.

Conclusions. Resection with extended end-to-end anastomosis yields a low mortality and particularly a low recoarctation rate and is our procedure of choice for infants with coarctation of the aorta.

Section snippets

Patients and methods

From November 1991 through May 1997, 55 infants with COA underwent surgical repair by REEEA at the Children’s Memorial Hospital, Chicago, Illinois. During this period 4 infants who would have been candidates for REEEA had other operations. One child with a Taussig-Bing anomaly and COA had a Hanley-type repair of the coarctation [10]. One 5-month-old child had a Gore-Tex (W.L. Gore & Associates, Flagstaff, AZ) patch aortoplasty. Two infants had subclavian flap aortoplasty during the transition

Results

A summary of postoperative mortality and morbidity after REEEA is displayed in Table 1. There was one operative death for an early mortality of 1.8%. The death occurred 26 days after simultaneous repair of COA and VSD in a patient who went to the operating room at 7 days of age while being treated with extracorporeal membrane oxygenation for meconium aspiration. The child died of respiratory failure related to the meconium aspiration. There were two late deaths: 1 child who was repaired through

Comment

Advances in preoperative, intraoperative, and postoperative management have improved to the point where the mortality rate for all types of neonatal coarctation repair has become quite low. Most patients are now taken to the operating room in hemodynamically stable condition thanks to ductal patency from prostaglandin E1 infusion. The remaining surgical challenge is the prevention of residual or recurrent coarctation. The technique of REEEA addresses many of the anatomic features that can cause

Acknowledgements

We thank Dr Edward Chen for the statistical analyses.

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