Isolated Aortic Coarctation in Neonates and Infants: Results of Resection and End-to-End Anastomosis

https://doi.org/10.1016/S0003-4975(96)00502-5Get rights and content

Background

Operative resection is the treatment of choice for native aortic coarctation in most institutions. The ideal timing for elective repair is still a matter of debate. This study evaluated one institution's results with resection and end-to-end anastomosis in the first year of life.

Methods

Between January 1987 and December 1993, 46 neonates and infants with functionally isolated aortic coarctation underwent operative resection and end-to-end anastomosis. For the patients included in the study, all hospital records, catheterization data, and operative protocols were evaluated for retrospective analysis. To obtain valid follow-up information, all patients were systematically seen on an outpatient basis during 1994.

Results

After a mean follow-up of 49 ± 24 months (range, 13 to 95 months), recoarctation (arm-leg blood pressure gradient >20 mm Hg) occurred in 5 of 26 patients with neonatal operations (19%) and in 1 of 20 patients with operations in infancy (5%, p = not significant). Four of these 6 children with recoarctation needed reintervention. The other 2 patients had only mild recoarctation (gradients of 22 and 30 mm Hg, respectively) and were not treated. In all 6 patients, recoarctation was diagnosed within the first 6 months postoperatively. During the whole follow-up period, right arm systolic blood pressures slightly above the 90th percentile of normal developed in 11 of the patients (24%) (7 in the group with neonatal operation and 4 after operation in infancy; p = not significant).

Conclusions

Resection with end-to-end anastomosis was shown to be an adequate therapeutic strategy for isolated aortic coarctation in neonates and infants. The results indicate that already beyond the neonatal age, there is a relatively low incidence of recoarctation.

Section snippets

Patients

Neonates (<1 month of life) and infants (1 to 12 months) who underwent repair for isolated coarctation in the period between January 1987 and December 1993 were enrolled in this study. For the 46 patients who were included, all hospital records, catheterization data, and operative protocols were reevaluated for retrospective analysis. During the study period, all patients were operated on by the same surgeon (G.Z.) using basically the same operative approach. To better study the effect of

Patient Characteristics

Forty-six patients were operated on for aortic coarctation without hemodynamically relevant associated intracardiac lesions during the study period and had recent follow-up evaluation available. Thirty-four (74%) of the patients were male and 12 (26%) were female. Twenty-six patients were operated on in the neonatal period, with a mean age at operation of 12 ± 8 days (range, 3 to 29 days) and a mean weight at operation of 3.5 ± 0.5 kg (range, 2.7 to 4.5 kg). The other 20 patients were operated on

Comment

Operation is the treatment of choice for symptomatic native aortic coarctation in neonates and infants. Primary balloon dilation of coarctation has been successful in relieving the stenosis, but recent observations showed a higher rate of restenosis after balloon dilatation than after operative treatment in neonates [1] and in infants [9].

As for operative therapy, especially in neonates and infants, there is an ongoing debate about the ideal operative technique to achieve the lowest rate of

Invited Commentary

Doctor Pfammatter and his associates have presented an excellent series of neonates and infants with isolated coarctation and have demonstrated that resection with end-to-end anastomosis undoubtedly is of great value as an operative technique. There is no dispute about this conclusion, and many of our colleagues would agree. I would like to expand their observations as this report nicely demonstrates the need to view coarctation as an entity with a wide spectrum. Pfammatter and associates state

References (25)

Cited by (40)

  • Coarctation of the aorta: Prenatal assessment, postnatal management and neonatal outcomes

    2022, Seminars in Perinatology
    Citation Excerpt :

    Surgical repair of Coa is usually performed via a left lateral thoracotomy (without cardiopulmonary bypass) when the stenosis is discrete or a short segment. The standard approach is resection of the narrowed aorta followed by an end-to end anastomosis.49 For longer segment narrowing, an extended prosthetic patch aortoplasty is performed.

  • Balloon-expandable stents for recoarctation of the aorta in small children. Two centre experience

    2018, International Journal of Cardiology
    Citation Excerpt :

    Hence, a strategy for later on treatment needs to be developed. Today surgery for native coarctation shows excellent results [19–21]. In contrast to that, it is known for years that surgical treatment of recurrent CoA in young patients is associated with an increased rate of complications.

  • MRI in adult patients with aortic coarctation: Diagnosis and follow-up

    2015, Clinical Radiology
    Citation Excerpt :

    This is not so useful in a patient with a significantly hypoplastic arch, when an extended repair or a subclavian flap is needed. The frequency of re-coarctation depends on the age at initial repair, being approximately 10% overall but up to 20% in those repaired as neonates.20 Patch aortoplasty involves augmentation of the coarctation site by the insertion of a patch of synthetic material, such as Dacron (Fig 7c).

  • Prediction of recurrent coarctation by early postoperative blood pressure gradient

    2011, Journal of Thoracic and Cardiovascular Surgery
    Citation Excerpt :

    Wu and colleagues2 also reported transverse arch diameter as a risk factor for reCoA. As in the other studies, reCoA developed within the first year of operation in most of the patients who developed reCoA.1,3 Although reCoA developed in 10 of the 11 patients within the first year, reCoA developed approximately 3 years postsurgery in only 1 patient.

View all citing articles on Scopus
View full text