Related Experiment Videos
Comparison of operations for coarctation of the aorta in infants
Insights
Subclavian flap angioplasty is a safe and effective treatment for coarctation of the aorta in infants. This surgical technique resulted in lower reoperation rates and improved long-term outcomes compared to resection.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Congenital Heart Disease
Background:
- Coarctation of the aorta is a serious congenital heart defect requiring surgical intervention in infants.
- Infantile coarctation often presents with congestive heart failure and is frequently associated with other cardiac anomalies.
Purpose of the Study:
- To compare the safety and effectiveness of different surgical techniques for treating coarctation of the aorta in infants.
- Specifically, to evaluate subclavian flap angioplasty against resection in terms of early outcomes, reoperation rates, and long-term pressure gradients.
Main Methods:
- A retrospective review of 33 infants (4 days to 1 year old) undergoing surgical repair for coarctation of the aorta over 12 years.
- Surgical methods included resection, patch aortoplasty, bypass, and subclavian flap angioplasty, with associated procedures like pulmonary artery banding and patent ductus arteriosus ligation.
- Comparison of aortic crossclamp times, 30-day mortality, reoperation rates, and arm-to-leg pressure gradients between surgical groups.
Main Results:
- Subclavian flap angioplasty had a shorter aortic crossclamp time compared to resection (P < 0.05).
- Thirty-day mortality was 13.9% (5 patients), primarily in younger infants with intracardiac anomalies.
- While early pressure gradients were similar, long-term arm-to-leg pressure gradients were significantly lower after subclavian flap angioplasty (8 mmHg) than after resection (34 mmHg) (P < 0.05).
Conclusions:
- Subclavian flap angioplasty is a safe and more effective surgical option for treating coarctation of the aorta in infants compared to resection.
- The technique demonstrates superior long-term hemodynamic results, reducing the incidence of recurrent or residual coarctation.
- Infants undergoing subclavian flap angioplasty experienced better long-term outcomes regarding blood pressure gradients.
Abstract:
During a 12-year-period, 33 infants 4 days to 1 year old underwent 36 operations for treatment of coarctation of the aorta. Associated cardiac anomalies were present in 27 infants (81.8%). All patients presented with congestive heart failure and underwent cardiac catheterization and aortography. Resection was performed in 11 infants, patch aortoplasty in 6, bypass in 2 and subclavian flap angioplasty in 17. Pulmonary artery banding was performed in 4 patients and ligation of a patent ductus arteriosus in 21 patients. Aortic crossclamp time was shorter in the 17 patients who had subclavian flap angioplasty than in 9 patients who had resection (P less than 0.05). Thirty-day mortality was 5 patients (13.9%); all were under 2 months of age at operation and had intracardiac anomalies. Four of them had resection and one had bypass. Mean follow-up was 5 years. Reoperation for recurrent or residual coarctation was performed in 5 patients after resection, 2 after patch aortoplasty and 2 after subclavian flap angioplasty. There was no significant difference in early postoperative arm-to-leg pressure gradients between patients who had resection and patients who had subclavian flap procedure. However, at last follow-up arm-to-leg pressure gradients were lower in 9 infants after subclavian flap (8 +/- 10.1 mmHg) than in 5 infants of similar age who had resection (34 +/- 23.9 mmHg) (P less than 0.05). Subclavian flap angioplasty is safe and more effective than resection for treatment of aortic coarctation in infants.