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Coarctation repair in neonates with subclavian-sparing advancement flap
B K Sharma1, M Calderon, D A Ott
1Department of Cardiovascular Surgery, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston 77225-0345.
Insights
A modified subclavian-sparing advancement flap technique offers a safe and effective repair for severe coarctation of the aorta in neonates, preserving arm blood flow.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- Severe coarctation of the aorta presents significant challenges in neonates.
- Traditional repair methods may have limitations regarding blood supply to the left arm.
Purpose of the Study:
- To evaluate a modified subclavian-sparing advancement flap technique for neonatal coarctation repair.
- To assess the safety, efficacy, and long-term outcomes of this surgical modification.
Main Methods:
- The modified technique was applied to 7 neonates (3-30 days old) with severe coarctation of the aorta.
- The repair involved advancing the left subclavian artery origin as a flap via left thoracotomy, preserving left arm blood flow.
- Follow-up included clinical examination and Doppler echocardiography for up to 2.25 years.
Main Results:
- No mortality occurred in the 7 treated neonates.
- All repairs demonstrated patency at long-term follow-up (mean 2 years).
- 6 out of 7 patients had no clinically significant gradient post-repair; one required balloon angioplasty at 1 year.
Conclusions:
- The subclavian-sparing advancement technique is a viable option for neonatal coarctation repair.
- This method offers the benefits of flap aortoplasty while maintaining left arm perfusion.
- Individualized surgical approaches are recommended due to the complex anatomy of coarctation of the aorta.
Abstract:
A modification of the technique of using the subclavian-sparing advancement flap for severe coarctation of the aorta was successfully used in 7 neonates ranging in age from 3 to 30 days (mean age, 12 days). Four of the 7 patients had associated cardiac defects with congestive heart failure. The procedure was performed through a left thoracotomy incision, and the coarctation repair was performed by advancing the origin of the left subclavian artery as a flap while preserving flow to the left arm. No deaths occurred, and there was patency of the repair in all patients at follow-up ranging from 1 1/2 to 2 1/4 years (mean, 2 years). In 7 of the 8 patients there was no clinically significant gradient either by examination or Doppler echocardiography at follow-up. One patient underwent balloon angioplasty at the time of catheterization to evaluate other cardiac defects 1 year postoperatively, at which time he was noted to have a peak systolic gradient of 30 mm Hg across the repair site. The technique of subclavian-sparing advancement is a reasonable addition to the surgical armamentarium for coarctation repair in neonates. It provides the advantages of subclavian flap aortoplasty without sacrificing the blood supply to the left arm. Because of the unique anatomic variations associated with coarctation of the aorta, we suggest that the choice of repair be individualized for patients with this condition.