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Published on: December 11, 2017
Coarctation of aorta repair at the National Heart Institute (1983-1994)
S M S J Adeeb1, H Leman, A Sallehuddin
1Division of Cardiothoracic Surgery, Department of Surgery, Hospital University Kebangsaan Malaysia, Kuala Lumpur.
Insights
Surgical repair of coarctation of the aorta has evolved. While resection and end-to-end anastomosis is now preferred, early use was linked to higher morbidities, unlike other procedures.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
Background:
- Coarctation of the aorta is a congenital heart defect requiring surgical intervention.
- Surgical approaches have evolved, with a shift towards resection and end-to-end anastomosis.
- Associated cardiac anomalies are common in patients with coarctation of the aorta.
Purpose of the Study:
- To review the historical surgical approaches for coarctation of the aorta.
- To compare the outcomes of different surgical techniques, including subclavian flap aortoplasty and resection with end-to-end anastomosis.
- To identify factors influencing perioperative mortality and morbidity.
Main Methods:
- Retrospective analysis of surgical cases for coarctation of the aorta.
- Review of procedures including resection and end-to-end anastomosis, subclavian flap aortoplasty, patch aortoplasty, and synthetic tube graft interposition.
- Correlation of perioperative mortality and morbidity with patient age, cardiac failure severity, and surgical procedure.
Main Results:
- Resection and end-to-end anastomosis is now the preferred surgical approach.
- Perioperative mortality was 5.26%, associated with younger age and severe cardiac failure.
- No significant difference in mortality was observed between different surgical procedures or complexity of congenital defects.
- Early use of resection and end-to-end anastomosis was associated with a higher incidence of morbidities.
Conclusions:
- Surgical management of coarctation of the aorta has transitioned to resection and end-to-end anastomosis.
- While mortality rates were similar across procedures, early morbidities were higher with resection and end-to-end anastomosis.
- Patient factors like age and cardiac failure severity significantly impact perioperative outcomes.
Abstract:
This retrospective study illustrates our approach to this problem over the years, from performing subclavian flap aortoplasty initially to the more accepted procedure now, which is resection and end-to-end anastomosis. Coarctation of aorta in our population is seen in a varying age groups and are also associated with other cardiac anomalies including both acyanotic and cyanotic congenital cardiac defects. Therefore a wide variety of surgical procedures were performed including resection of the coarcted segment and end-to-end anastomosis, subclavian flap aortoplasty, patch aortoplasty and synthetic tube graft interposition. Subclavian flap aortoplasty is not widely practised anymore in favour of resection with end-to-end anastomosis. Fifty four point four percent of patients had isolated coarctation, 10.5% had associated valvular defects, 28.1% had other simple congenital defects and 7.0% had associated complex cyanotic congenital defects. Perioperative mortality was 5.26% and is correlated with the younger age of patients at time of surgery and severity of cardiac failure at time of presentation. We did not see any difference in mortality for patients with complex congenital disease or between the different surgical procedures. However, we did find that in the early period when resection with end-to-end anastomosis was performed, there was a significantly higher incidence of morbidities.
