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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Is surgical intervention still indicated in recurrent aortic arch obstruction?
Joy Zoghbi1, Alain Serraf, Siamak Mohammadi
1Marie Lannelongue Hospital, Paris-Sud University, France.
The Journal of Thoracic and Cardiovascular Surgery
|January 31, 2004
Summary
Surgical reoperation for recurrent aortic arch obstruction is safe and effective, showing lower complication and recurrence rates than balloon dilatation. This approach is recommended, particularly for patients over 4 years old with aortic arch hypoplasia.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Balloon dilatation is a standard treatment for recurrent aortic arch obstruction.
- The optimal treatment strategy, especially comparing balloon dilatation with surgical reoperation, remains unclear.
Purpose of the Study:
- To compare the outcomes of balloon dilatation versus surgical reoperation for recurrent aortic arch obstruction.
- To determine patient characteristics that may favor one treatment approach over the other.
Main Methods:
- A retrospective review of 97 patients who underwent reintervention for recurrent aortic arch obstruction between 1983 and 20XX.
- Patients were divided into two groups: balloon dilatation (n=42) and surgical reoperation (n=55).
- Surgical approaches included left thoracotomy, end-to-end anastomosis, subclavian flap repair, conduit insertion, and patch enlargement, with recent use of an anterior approach.
Main Results:
- Surgical reoperation had lower rates of major complications (0% vs 4%) and recurrence (5 vs 14, P <.0004) compared to balloon dilatation.
- Mortality was low in both groups (1 early death in surgery, 2 late deaths in dilatation).
- Systemic hypertension was normalized in most patients in both groups at long-term follow-up.
Conclusions:
- Surgical reoperation for recurrent aortic arch obstruction is a safe and effective treatment option.
- Reoperation demonstrates superior outcomes regarding complications and recurrence compared to balloon angioplasty.
- Surgical intervention is particularly recommended for patients older than 4 years and those with aortic arch hypoplasia.
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