Isolated Coarctation Repair in Neonates and Infants Through Left Thoracotomy: Short-Term Outcomes
Alexandre Noboru Murakami1, Ulisses Alexandre Croti2, Francisco Candido Monteiro Cajueiro3
1Cardiology Surgery Department, Serviço de Cirurgia Cardíaca do Norte do Paraná, Universidade Estadual de Londrina (UEL), Londrina, Paraná, Brazil.
Insights
This study analyzed surgical techniques for coarctation of the aorta (CoAo) in 72 pediatric patients. Extended end-to-end anastomosis was prevalent, with low 30-day mortality, indicating effective treatment for CoAo.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Thoracic Surgery
Background:
- Coarctation of the aorta (CoAo) repair often involves subclavian artery access or interposition grafts.
- Surgical outcomes depend on various patient and procedural factors.
- Left thoracotomy without cardiopulmonary bypass is a viable surgical approach.
Purpose of the Study:
- To evaluate the impact of surgical and anatomical factors on early outcomes of CoAo repair.
- To analyze the effectiveness of different anastomosis techniques in pediatric patients.
- To assess outcomes of CoAo surgery performed without cardiopulmonary bypass.
Main Methods:
- Quantitative, observational, cross-sectional study of 72 patients undergoing CoAo repair (2010-2017).
- Patients stratified into three age groups: neonates, infants, and children/adolescents.
- Analysis of surgical techniques (end-to-end vs. extended end-to-end anastomosis) and anatomical variations.
Main Results:
- Aortic arch hypoplasia (30.8%) and ventricular septal defect (13.2%) were common comorbidities.
- Extended end-to-end anastomosis was the predominant technique (68%), especially in neonates (91.2%).
- Thirty-day mortality was low at 1.4%.
Conclusions:
- Extended end-to-end anastomosis is frequently used in pediatric CoAo repair, particularly in neonates with arch hypoplasia.
- Surgical treatment of CoAo without cardiopulmonary bypass via left thoracotomy demonstrated low mortality.
- Moderate postoperative morbidity was observed within the first 30 days.
Introduction:
End-to-end anastomosis and extended end-to-end anastomosis are typically used as surgical approaches to coarctation of the aorta (CoAo) with access at the subclavian artery or an interposition graft. The objective of this study is to analyze the impact of surgical and anatomical characteristics and techniques on early outcomes after surgical treatment of CoAo without cardiopulmonary bypass through left thoracotomy.
Methods:
This is a quantitative, observational, and cross-sectional analysis of patients who underwent repair of CoAo between July 1, 2010 and December 31, 2017. Seventy-two patients were divided into three groups according to age: 34 in group A (≤ 30 days), 24 in group B (31 days to one year), and 14 in group C (≥ 1 year to 18 years).
Results:
Aortic arch hypoplasia was associated in 30.8% of the cases, followed by ventricular septal defect (13.2%). The preductal location was more frequent in group A (73.5%), ductal in group B (41.7%), and postductal in group C (71.4%). Long coarcted segment was predominant in groups A and C (61.8% and 71.4%, respectively) and localized in group B (58.3%). Extended end-to-end anastomosis technique was prevalent (68%), mainly in group A (91.2%). Mortality in 30 days was 1.4%.
Conclusion:
Most of the patients were children under one year of age, and extended end-to-end anastomosis was the most used technique, secondary to arch hypoplasia. Further, overall mortality was low in spite of moderate morbidity in the first 30 postoperative days.
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