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Coarctation of the aorta, early and late results of various surgical techniques
H Rostad1, M Abdelnoor, S Sørland
1Department of Surgery, National Hospital, Rikshospitalet, Oslo, Norway.
Insights
Surgical repair of coarctation of the aorta, particularly aortoplasty with a prosthetic patch, showed lower rates of recoarctation compared to resection and end-to-end anastomosis.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- Coarctation of the aorta is a congenital heart defect requiring surgical intervention.
- Surgical techniques for coarctation repair have evolved, with varying outcomes.
- Infants and children represent a significant patient population for this condition.
Purpose of the Study:
- To evaluate the surgical outcomes for coarctation of the aorta in a pediatric cohort.
- To compare the effectiveness of aortoplasty with a prosthetic patch versus resection and end-to-end anastomosis.
- To assess the incidence and management of recoarctation.
Main Methods:
- Retrospective analysis of 158 patients (1 day to 16.4 years) operated on for coarctation of the aorta between 1973-1983.
- Primary surgical techniques included aortoplasty with a prosthetic patch and resection with end-to-end anastomosis.
- Analysis of associated cardiovascular anomalies, mortality, and recoarctation rates.
Main Results:
- Aortoplasty with a prosthetic patch was the predominant procedure (114 patients).
- Associated cardiovascular anomalies were present in 42% of patients.
- Recoarctation rates were significantly higher with resection and end-to-end anastomosis (25%) compared to aortoplasty with a prosthetic patch (6.7%).
Conclusions:
- Aortoplasty with a prosthetic patch is associated with a lower frequency of recoarctation compared to resection and end-to-end anastomosis.
- Surgery for recoarctation using aortoplasty with a prosthetic patch yielded favorable outcomes with no complications or deaths in this series.
- Aneurysmal dilatation adjacent to the prosthetic patch is a potential long-term complication.
Abstract:
In the 10-year period 1973-1983, 158 patients aged one day to 16.4 years were operated upon for coarctation of the aorta; 25% of them were less than one month of age. The main surgical procedure was aortoplasty with a prosthetic patch (114 patients), and resection and end-to-end anastomosis (36 patients). Associated cardiovascular anomalies were found in 42%. There were 11 early and 6 late deaths and the majority of these were due to severe coexistent cardiac lesions. The frequency of moderate and severe recoarctation was much higher in patients operated on with resection and end-to-end anastomosis than in those with aortoplasty and prosthetic patch, 25% and 6.7%, respectively. In 18 patients, surgery for recoarctation was necessary using aortoplasty and a prosthetic patch technique. There were no postoperative complications or deaths in these patients. So far, in 2 cases with a prosthetic patch, aneurysmal dilatation of the aorta adjacent to the patch has developed.