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[Surgical treatment of coarctation and interrupted aortic arch complex in infants]
1Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan.
Insights
One-stage biventricular repair offers good outcomes for neonates with coarctation and interrupted aortic arch complex. This approach minimizes mortality and recoarctation rates, with catheter intervention proving effective for recoarctation.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Aortic Arch Anomalies
Context:
- Review of 142 neonates and infants with coarctation and interrupted aortic arch complex.
- Surgical repair outcomes at Fukuoka Children's Hospital (1991-2000).
- Comparison of one-stage versus two-stage biventricular repair strategies.
Purpose:
- To evaluate the effectiveness of one-stage biventricular repair for complex aortic arch anomalies.
- To compare mortality and recoarctation rates between one-stage and two-stage repair methods.
- To assess the utility of descending aorta cannulation and cerebral perfusion techniques.
Summary:
- One-stage repair showed favorable outcomes for coarctation and interrupted aortic arch complex, with lower mortality rates compared to two-stage repairs.
- Recoarctation rates were low (5.3% and 2.1%) and successfully managed with catheter intervention, avoiding reoperation.
- The anterior approach with descending aorta cannulation and cerebral perfusion is effective, but two-stage repair remains viable for critically ill patients.
Impact:
- Demonstrates the efficacy of one-stage biventricular repair in improving outcomes for complex congenital heart defects.
- Highlights the importance of surgical technique, including cerebral perfusion, in minimizing complications.
- Provides evidence supporting tailored surgical approaches based on patient condition and anomaly severity.
Abstract:
One hundred forty-two consecutive neonates or early infants with coarctation and interrupted aortic arch complex who underwent biventricular repair at the Fukuoka Children's Hospital between January 1991 and December 2000 were reviewed. One-stage repair was performed in 33 patients (35%) with coarctation complex and in 41 patients (85%) with interrupted aortic arch complex. The overall mortality rate was 6.1% in one-stage repair and 6.6% in two-stage repair of coarctation complex patients and 9.8% in one-stage repair and 28.6% in two-stage repair of interrupted aortic arch complex patients. The recoarctation rate was 5.3% in coarctation complex and 2.1% in interrupted aortic arch complex. All patients with recoarctation underwent successful catheter intervention and required no reoperation. In conclusion, one-stage repair of interrupted aortic arch and coarctation complex with the anterior approach resulted in good outcomes. Then descending aorta cannulation through a median sternotomy combined with the cerebral perfusion technique enables complete avoidance of circulatory arrest and is a useful technique. However, a two-stage procedure can be useful in the patients whose condition has deteriorated substantially or in whom intracardiac anomalies are severe.
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