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Surgical options for proximal and distal transverse arch hypoplasia in infants with coarctation
Cong Li1, Jidan Ma2, Yichen Yan1
1Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Insights
End-to-side anastomosis (ESA) for aortic arch reconstruction in infants increases the risk of recoarctation. Patch repair methods may offer better long-term outcomes for proximal and distal transverse arch hypoplasia.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Vascular Surgery
Background:
- Proximal and distal transverse arch (PDTA) hypoplasia requires surgical reconstruction.
- No consensus exists on the optimal initial surgical technique for PDTA hypoplasia.
Purpose of the Study:
- To review surgical options for PDTA hypoplasia in Chinese infants.
- To identify risk factors for recoarctation after initial aortic arch reconstruction.
Main Methods:
- Retrospective review of 121 infants undergoing initial aortic arch reconstruction (2010-2020).
- Surgical techniques included end-to-side anastomosis (ESA) and various patch repairs (autologous pericardial, bovine pericardial, autologous pulmonary artery).
- Kaplan-Meier analysis for freedom from recoarctation; Cox regression for risk factor identification.
Main Results:
- Recoarctation occurred in 44 (36.4%) patients.
- End-to-side anastomosis (ESA) was identified as an independent risk factor for recoarctation (HR=2.13, P=0.020).
- Median follow-up was 679 days.
Conclusions:
- Initial aortic arch reconstruction using ESA is an independent risk factor for late recoarctation in infants.
- Patch repair techniques may be associated with lower rates of recoarctation.
Background:
Although various surgical techniques have been reported for aortic arch reconstruction for proximal and distal transverse arch (PDTA) hypoplasia, no consensus has been reached on a surgical option for initial arch reconstruction. This study was undertaken to review various arch reconstruction options for PDTA hypoplasia in Chinese infants.
Methods:
A retrospective review of 121 infants who underwent initial arch reconstruction of the proximal and distal aortic arches between 2010 and 2020 was performed. Freedom from recoarctation was analyzed using Kaplan-Meier analysis. Univariate and multivariable Cox regression analyses were performed to determine perioperative data associated with an increased risk of recoarctation after surgery.
Results:
Aortic arch reconstruction was performed by end-to-side anastomosis (ESA) (n=37) or patch repair [autologous pericardial patch (APP), n=53; bovine pericardial patch (BPP), n=20; autologous pulmonary artery patch (APAP), n=11]. The relative diameter of the proximal arch was 0.51±0.07, and the relative diameter of the distal arch was 0.43±0.07. The median follow-up time was 679 (range, 388-1,362) days. Recoarctation was observed in 44 (36.4%) patients. ESA was an independent risk factor for further development of recoarctation after the initial aortic arch reconstruction [hazard ratio (HR) =2.13; P=0.020].
Conclusions:
Aortic arch reconstruction via ESA was an independent risk factor for late recoarctation of the proximal and distal aortic arches in patients who underwent the initial surgery in infancy.
Trial Registration:
Chinese Clinical Trials Registry ChiCTR2100048212.
