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Coarctation of the aorta in infants: which operation?
F Trinquet1, P R Vouhé, F Vernant
1Department of Thoracic and Cardiovascular Surgery, Hôpital Laënnec, Paris, France.
Insights
Surgical repair of aortic coarctation in infants shows that outcomes depend on associated heart conditions, not the repair method. Individualized surgical approaches are crucial for optimizing aortic anatomy and improving survival rates.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Aortic Coarctation Repair
Background:
- Aortic coarctation is a critical congenital heart defect requiring surgical intervention in infants.
- Outcomes in aortic coarctation repair are influenced by the complexity of associated cardiac anomalies.
- Various surgical techniques exist for aortic coarctation repair, each with potential benefits and risks.
Purpose of the Study:
- To evaluate the early mortality and long-term outcomes of different surgical repair methods for aortic coarctation in infants.
- To determine the impact of associated cardiac defects on survival and re-coarctation rates.
- To assess the effectiveness of specific surgical techniques, including subclavian flap angioplasty and end-to-end anastomosis.
Main Methods:
- Retrospective analysis of 178 infants undergoing aortic coarctation repair (age ≤ 3 months).
- Patients categorized into three groups: pure coarctation, coarctation with ventricular septal defects, and complex heart disease.
- Surgical repair methods included subclavian flap angioplasty, limited/extended resection with end-to-end anastomosis, and miscellaneous procedures.
Main Results:
- Early mortality varied significantly: 8% (Group 1), 11% (Group 2), and 37% (Group 3) (p < 0.001).
- Five-year actuarial survival rates were 90% (Group 1), 84% (Group 2), and 40% (Group 3).
- Recoarctation occurred in 11% of survivors; outcomes were driven by clinical status and associated anomalies, not repair type.
Conclusions:
- Surgical repair outcomes for infantile aortic coarctation are primarily determined by the presence and severity of associated cardiac anomalies.
- The choice of surgical technique for aortic coarctation repair should be individualized based on the infant's specific anatomy and clinical condition.
- Optimizing surgical strategy for each infant is essential for improving long-term survival and reducing the risk of recoarctation.
Abstract:
In this series, 178 infants (age, less than or equal to 3 months old) underwent repair of aortic coarctation. Pure coarctation was present in 63 patients (Group 1), 47 infants had additional ventricular septal defects (Group 2), and 68 patients had associated complex heart disease (Group 3). Subclavian flap angioplasty was used in 26 patients, limited resection and end-to-end anastomosis in 45 patients, extended resection and end-to-end anastomosis in 99 patients, and miscellaneous procedures in 8 infants. The early mortality was 8% for the first group, 11% for the second group, and 37% for the third group (p less than 0.001). Mean follow-up was 32 months and included 97% of patients. Actuarial survival at five years was 90% for the first group, 84% for the second group, and 40% for the third group. Recoarctation occurred in 15 operative survivors (11%); 7 necessitated reoperation. Freedom from recoarctation at five years was 89% after subclavian flap angioplasty, 81% after end-to-end anastomosis, and 86% following extended resection and end-to-end anastomosis. Early mortality and late results were not influenced by the type of coarctation repair but were determined by the clinical status and the presence of associated major cardiac anomalies. These results suggest that the surgical procedure should be individualized for each infant to optimize the aortic anatomy.