Modified extended end-to-end repair of coarctation in neonates and infants
S Y Deleon1, A Desikacharlu, J G Dorotan
1Department of Surgery and Anesthesia, Tulane University Medical Center, 1430 Tulane Avenue SL-22, New Orleans, LA 70112, USA. sdeleon1@tulane.edu
Insights
A modified extended end-to-end repair for coarctation of the aorta in infants offers a less invasive option. This technique, involving less aortic mobilization, shows promising results with successful outcomes in most patients.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- The classic extended end-to-end repair for coarctation of the aorta can lead to arch growth impairment due to scarring.
- Challenges in achieving adequate distance and mobilization exist in some neonates and infants.
Purpose of the Study:
- To evaluate the efficacy and safety of a modified extended end-to-end repair for coarctation of the aorta in neonates and infants.
- To present an alternative surgical approach with reduced aortic mobilization requirements.
Main Methods:
- A modified extended end-to-end repair was performed on 15 neonates and infants without significant arch hypoplasia.
- The anastomosis connected the posterior isthmus/subclavian artery base to the anterior descending aorta, creating a wider anastomosis.
- Follow-up extended up to 57 months (average 34 months).
Main Results:
- All 15 patients survived the procedure.
- Two patients developed significant postoperative gradients, successfully treated with balloon dilatation.
- The modified technique required less mobilization of the aortic arch and descending aorta.
Conclusions:
- The modified extended end-to-end repair is a viable alternative for coarctation of the aorta in neonates and infants.
- This approach is particularly beneficial for patients with a long isthmus.
- The technique minimizes aortic mobilization, potentially reducing growth impairment concerns.
Abstract:
Although the classic extended end-to-end repair is the procedure of choice in most neonates and infants with coarctation of the aorta, there is a problem of distance despite extensive mobilization and impairment of growth of the arch because of scarring in some patients. Since December 1999, 15 neonates and infants without significant arch hypoplasia have undergone a modified extended end-to-end repair of coarctation of the aorta at our institution. The anastomosis was performed between the posterior wall of the isthmus and base of the subclavian artery and anterior wall of the descending aorta, resulting in an anastomosis that was usually 1(1/2) times the diameter of the descending aorta. All patients survived and were followed up to 57 months (average, 34). Two patients developed significant gradients 3 months and 1 year postoperatively, respectively, probably from luxurious tissue growth at the suture line. Both were treated successfully with balloon dilatation. The modified extended end-to-end repair provides another option for repair of coarctation in neonates and infants. It requires less mobilization of the arch and descending aorta. It is particularly useful in patients with long isthmus.
