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Surgical correction of coarctation in early infancy: does surgical technique influence the result?
B J Messmer1, C Minale, E Mühler
1Department of Thoracic Surgery, University Hospital, Aachen, Germany.
Insights
Surgical repair of coarctation in infants showed low mortality, with outcomes depending on patient pathology, not surgical method. Restenosis rates varied by technique, with patch enlargement and subclavian displacement showing higher rates.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Thoracic Surgery
Background:
- Coarctation of the aorta is a critical congenital heart defect requiring surgical intervention in infancy.
- Early surgical repair aims to improve long-term outcomes and reduce cardiovascular complications.
- Evaluating different surgical techniques is crucial for optimizing treatment strategies in neonates and infants.
Purpose of the Study:
- To assess the outcomes of surgical repair for coarctation of the aorta in infants.
- To compare the efficacy and complication rates of four distinct surgical techniques.
- To identify predictors of mortality and restenosis following coarctation repair in early life.
Main Methods:
- Retrospective analysis of 53 infants (<1 year) undergoing coarctation repair between 1979-1988.
- Categorization of surgical techniques: resection with end-to-end anastomosis, patch enlargement, subclavian flap aortoplasty, and subclavian displacement aortoplasty.
- Evaluation of hospital mortality, restenosis rates, and reoperation rates with follow-up averaging 15-43 months.
Main Results:
- Hospital mortality was 7.5%, exclusively in infants with complex intracardiac defects.
- Neither patient age nor surgical technique influenced operative risk.
- Restenosis occurred in 19% of followed patients, with patch enlargement (42%) and subclavian displacement (43%) showing higher rates.
- Pathological conditions influenced outcomes, particularly in the patch enlargement group.
Conclusions:
- Coarctation repair outcomes in early infancy are primarily dictated by the underlying pathology rather than the specific surgical technique employed.
- While most techniques showed similar risks, patch enlargement and subclavian displacement techniques had higher restenosis rates.
- Careful consideration of pathological aspects is essential for selecting the optimal treatment method, with caution advised for the subclavian displacement technique.
Abstract:
Between 1979 and 1988, a total of 53 infants less than 1 year of age underwent repair of coarctation. Thirty-seven patients (70%) were younger than 3 months. Median age was 0.9 month. Four different surgical techniques were used: resection with end-to-end anastomosis, patch enlargement, subclavian flap aortoplasty, and subclavian displacement aortoplasty (Meier-Mendonca technique). Hospital mortality was 7.5% and was limited to patients with additional complex intracardiac defects. Neither age nor surgical technique had an influence on the operative risk. Follow-up averaged 15 to 43 months for the four different groups. Restenosis developed in 9 (19%) of 47 patients regularly followed up, 5 (11%) of whom have had reoperation. Age at operation was not a predictor for restenosis, which occurred in 17.4% of patients less than 1 month and 20.8% of those greater than 1 month of age at operation. Patch enlargement and the subclavian displacement technique demonstrated the highest restenosis rates (42% and 43%, respectively). However, patients who underwent patch enlargement had less favorable pathological conditions. It is concluded that results of coarctation repair in early infancy do not depend as much on the operative method itself as on the specific pathological aspect, which largely determines the method of treatment. Some reservation must be made in regard to the subclavian displacement technique.