Original ArticlesRepair of coarctation with resection and extended end-to-end anastomosis
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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