Repair of aortic coarctation in infancy: A 10-year clinical experience
Hamid Bigdelian1, Mohsen Sedighi2
1Department of Cardiovascular Surgery, Chamran Heart Center, Isfahan University of Medical Science, Isfahan, Iran.
Insights
Resection with end-to-end anastomosis is optimal for infant aortic coarctation repair, showing lower recoarctation rates and excellent survival compared to subclavian flap aortoplasty.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Defects
Background:
- Coarctation of the aorta is a congenital narrowing affecting approximately 4% of infants with congenital heart disease.
- Surgical repair is crucial for managing this condition.
- Two common surgical approaches include subclavian flap aortoplasty and resection with end-to-end anastomosis.
Purpose of the Study:
- To compare the surgical outcomes and survival rates of two distinct repair methods for congenital aortic coarctation in infants.
- To evaluate the efficacy of subclavian flap aortoplasty versus resection with end-to-end anastomosis.
Main Methods:
- A retrospective review of 105 infants undergoing aortic coarctation repair between 2000 and 2012.
- Group 1: 50 patients underwent subclavian flap aortoplasty.
- Group 2: 55 patients underwent resection with end-to-end anastomosis.
Main Results:
- No significant differences in intra- or postoperative variables between the two groups.
- Higher recurrence rate in the subclavian flap aortoplasty group (12%) compared to resection with end-to-end anastomosis (1.8%).
- Overall mortality was 2.8%, with survival rates of 96% for group 1 and 98.2% for group 2.
Conclusions:
- Resection with end-to-end anastomosis offers a low mortality rate and reduced incidence of recoarctation in infants.
- This technique provides an optimal prognosis for managing infantile coarctation of the aorta.
Background:
Coarctation of the aorta is a congenital narrowing of the upper descending aorta. The approximate incidence is 4% in live-born children with congenital heart disease. This study aimed to describe the surgical outcome and survival of patients undergoing congenital aortic coarctation repair via subclavian flap aortoplasty (group 1) or resection with end-to-end anastomosis (group 2).
Methods:
We retrospectively reviewed the clinical outcomes of 105 infants who underwent repair of aortic coarctation between 2000 and December 2012. Fifty patients (group 1) underwent subclavian flap aortoplasty and 55 (group 2) underwent resection with end-to-end anastomosis. Procedure details and early results were collected by retrospective review of hospital and clinic data.
Results:
The mean age of patients in group 1 was 6.73 ± 1.1 vs. 6.76 ± 1.2 months in group 2, and the mean weight was 6.01 ± 1.3 vs. 5.9 ± 1.0 kg, respectively. There were no significant differences among the intra- and postoperative variables in the 2 groups. Six patients in group 1 had a peak systolic gradient >20 mm Hg. The recurrence rate in group 1 was 12% vs. 1.8% in group 2 (p < 0.05). Overall mortality was 2.8%. Survival in group 1 was 96% vs. 98.2% in group 2.
Conclusion:
Repair of aortic coarctation in infancy by resection with end-to-end anastomosis can be performed with a low mortality rate and a low incidence of recoarctation, and it provides the optimal prognosis for coarctation in infancy.
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