Original article: cardiovascularSurgery for coarctation of the aorta in infants weighing less than 2 kg
Section snippets
Patient characteristics
Between August 1990 and December 1999, 18 consecutive neonates with a birth weight of less than 2 kg (median weight at surgery 1,330 g, range 800 to 1,950 g) underwent surgery for critical aortic coarctation at The Children’s Hospital (Boston, MA). This study was begun in 1990 because a previous study on low-birth weight neonates from our institution [2] spanned up to that date. All charts were retrospectively reviewed, including follow-up clinic notes and latest echocardiograms. All data
Operative results
All patients were operated on via a left posterolateral thoracotomy. The coarctation was resected and a primary end-to-end anastomosis was performed in 16 (89%) patients (with extension into the arch in 9), and 2 patients underwent resection of the coarctation and reverse subclavian flap augmentation of the distal arch with end-to-end anastomosis. In all cases, a running suture of 6-0 or 7-0 polypropylene was used. The median clamp time was 15.5 minutes (12 to 41 minutes). Arm-leg gradients
Comment
Repair of cardiac defects in low-birth and very low-birth weight neonates is increasingly performed in a reparative rather than palliative manner [1]. This study shows that this concept is also valid in this high-risk population. Small or obstructive left-sided structures and a hypoplastic aortic arch were risk factors for death, whereas very low-birth weight was associated with increased recoarctation rates.
Reported mortality rates for coarctation repair in low-birth infants vary from 12.5% to
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