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[Surgical treatment of coarctation of the aorta]
A Mizuno1, Y Nakamura, H Takayasu
1Department of Cardiovascular Surgery, Saitama Children's Medical Center.
Insights
For infants under one month, end-to-end anastomosis may reduce reoperation rates for coarctation of the aorta compared to subclavian flap repair. Patch aortoplasty is common for re-stenosis.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Context:
- Coarctation of the aorta is a congenital heart defect requiring surgical repair.
- Surgical techniques include subclavian flap repair, end-to-end anastomosis, patch aortoplasty, and interposition grafts.
- Reoperation is a concern, particularly in young infants.
Purpose:
- To evaluate the effectiveness of different surgical repair methods for coarctation of the aorta.
- To identify risk factors for reoperation in infants.
- To recommend optimal surgical techniques for specific age groups.
Summary:
- This study analyzed 37 cases of coarctation of the aorta repair in patients aged 4 days to 15 years.
- Subclavian flap repair, end-to-end anastomosis, and patch aortoplasty were the primary methods used.
- A higher incidence of reoperation was observed after subclavian flap repair in infants under one month old.
- Recurrent coarctation may stem from retained abnormal tissue, potentially ductal or intimal shelf remnants.
- End-to-end anastomosis is suggested as a preferred technique over subclavian flap angioplasty for neonates.
- Patch aortoplasty was the most frequent method for re-stenosed cases.
Impact:
- Findings may guide surgical choices to minimize reoperation rates in complex congenital heart disease.
- Recommendations can improve long-term outcomes for infants undergoing coarctation of the aorta repair.
- Understanding mechanisms of re-stenosis can lead to improved surgical strategies and patient care.
Abstract:
Repair of coarctation of the aorta was performed in 37 cases (31 patients, 6 patients of reoperation) ranging from 4 days old to 15 years old. Subclavian flap repair were performed in 15, resection and end-to-end anastomosis in 14, patch aortoplasty in 6, and interposition graft in 2. Subclavian flap angioplasty or end-to-end anastomosis is considered the procedure of choice in infants. However, the incidence of reoperation significantly increased in patients younger than age one month at initial subclavian flap repair. Mechanism of recurrent coarctation may be possibly related to retention of abnormal tissue, which is possibly ductal and/or intimal shelf, with the potential for proliferation and luminal narrowing. We suggest that in applicable case end-to-end anastomosis rather than subclavian flap angioplasty may be the surgical technique of choice in infants less than one month of age, and the most common reoperation technique was patch aortoplasty in re-stenosed cases.