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Revisiting subclavian flap repair for neonates and small infants
Mustafa Kir1, Baran Ugurlu2, Nurettin Unal3
1Mustafa Kir, MD, Department of Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Inciralti-Izmir 35340 Turkey.
Insights
Subclavian flap angioplasty (SFA) is a safe technique for infant coarctation repair. Outcomes depend more on aortic arch anatomy than the SFA procedure itself.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Vascular Surgery
Background:
- Coarctation of the aorta is a common congenital heart defect.
- Arch hypoplasia frequently accompanies coarctation in infants.
- Subclavian flap angioplasty (SFA) is a frequently used repair technique.
Purpose of the Study:
- To evaluate the safety and efficacy of SFA in infants with coarctation.
- To determine re-coarctation rates and recurrent hypertension post-SFA.
- To assess left arm development after SFA repair.
Main Methods:
- Retrospective analysis of 38 infants (<3 months) undergoing SFA between 2007-2013.
- Inclusion of patients with pulmonary banding; exclusion of complex pathologies and low birth weight infants.
- Serial echocardiography for follow-up.
Main Results:
- Mean follow-up was 21 months.
- 12% of patients had aortic arch hypoplasia.
- Re-intervention required in 7.8% of patients, primarily due to residual gradients.
Conclusions:
- SFA is a safe repair technique for neonates and small infants.
- Aortic arch anatomy, not SFA technique, influences post-operative gradients and intervention need.
Objective:
We have utilized subclavian flap angioplasty (SFA) frequently in infants with coarctation particularly in patients with arch hypoplasia which is quite frequent. We have followed these patients with serial echocardiography and have analyzed our results in this study to determine recoartation rates, recurrent hypertension and left arm development.
Methods:
Thirty eight infants less than 3 months age (22 boys and 16 girls, mean age was 28±22.6 days) operated at Dokuz Eylul University Hospital between August 2007 - December 2013. Twelve (32%) patients with pulmonary banding due to accompanying VSD or AVSD were included to the study, those infants with complex pathologies such as transposition of great arteries or single ventricle, while the patients less than 1000 gram in weight were excluded.
Results:
The mean follow-up time was 21 months (1-76 months). Twelve (32%) patients had aortic arch hypoplasia proximal to the left subclavian artery. Operative mortality was found 7.7% for isolated coarctation, 16% for coarctation repair with pulmonary banding. In 5 patients, a residual gradient was detected and re intervention was required in 7.8% patients with balloon angioplasty.
Conclusion:
Subclavian flap angioplasty is a safe repair technique in small infants and neonates. High gradients and intervention more likely depends on the anatomy of the aortic arch rather than the subclavian flap angioplasty technique.
