Original article: cardiovascular
Is extended arch aortoplasty the operation of choice for infant aortic coarctation? Results of 15 years' experience in 181 patients

Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.
https://doi.org/10.1016/j.athoracsur.2003.07.045Get rights and content

Abstract

Background

Recurrent coarctation is an ever-present complication of surgical treatment of coarctation of aorta (CoA) among infants. No single operation appears to have a clear superiority.

Methods

From January 1, 1986, to June 30, 2002, a consecutive series of 181 patients less than 1 year of age (range 1 to 300 days, median 13.5 days) were referred for CoA repair. Neonates accounted for 135 patients, and hypoplastic arch (less than 1 mm/kg plus 1) was present in 107 infants. Coarctation of aorta was simple (group 1) in 71 patients; complicated by ventricular septal defect (group 2) in 62; and complicated by complex congenital heart disease (group 3) in 48. All patients were assessed by right arm/left leg Dynamap pressures and routine follow-up was performed by the cardiologists. Follow-up was complete in all patients (range 6 months to 16 years, median 7.5 years).

Results

The overall hospital/30-day mortality was 0.5% (group 1 = 0, group 2 = 0, group 3 = 1 [2.0%]). Complications other than recoarctation occurred in 5 patients (2.7%). Late mortality occurred in 15 (11 at intracardiac repair). Recoarctation, ie, a gradient of more than 20 mm Hg, occurred in 4 patients (2.2%). All 4 patients were noted to have a gradient of more than 10 mm Hg (right arm/left leg) postoperatively and as such had residual coarctation. All 4 were successfully treated by balloon aortoplasty.

Conclusions

Extended arch aortoplasty in association with ductal and coarctation excision provides excellent coarctation repair with a low incidence of recoarctation. Recoarctation occurred only in proximal aortic arch hypoplasia or low birth weight. Balloon aortoplasty easily and effectively relieved the recoarctation in all cases.

Section snippets

Material and methods

From January 1, 1986, to June 30, 2002, 181 infants less than 1 year old underwent repair of CoA using EAA. The median age was 13.5 days (range 1 to 300 days). The median weight at operation was 3.7 kg (range 0.85 to 10.5 kg). Congestive heart failure was present in 164 patients (91%). All patients were treated with medical therapy first, including prostaglandin infusion, with correction of acid-base balance and ventilation if necessary. A total of 135 infants (74%) were neonates.

The patients

Early results

The hospital mortality for the entire series was 0.5%; this single death occurred in a patient from group 3 with univentricular heart, double-inlet left ventricle, and associated pulmonary artery banding. No patients in group 1 or 2 died. Complications occurred in 5 (2.7%) patients, 2 infants required plication of left hemi-diaphragm because of left phrenic nerve palsy at 4 weeks postoperatively. Chylothorax occurred in 3 infants, which settled with chest tube drainage and a medium-chain

Comment

Neonates and infants with CoA generally present in congestive cardiac failure and at times are critically ill. Thanks to today's perioperative therapy, especially use of prostaglandin E1 to maintain ductal patency and distal body perfusion, these patients come to surgery in optimum condition. The mortality rate of all types of neonatal and infantile coarctation has decreased in recent years. However, much debate continues on the choice of repair technique, and the outcome is best measured not

References (25)

Cited by (63)

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