Isolated coarctation repair through a left thoracotomy in children
Shiraslan Bakhshaliyev1, Serhat Bahadır Genç1, Görkem Çitoğlu1
1Pediatric Cardiac Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, Istanbul, Turkey.
Insights
Surgical repair of isolated aortic coarctation using left thoracotomy and end-to-end anastomosis shows low complication rates. Long-term surveillance is crucial for managing potential recoarctation and hypertension post-surgery.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- Isolated aortic coarctation is a congenital heart defect requiring surgical intervention.
- Left thoracotomy with end-to-end anastomosis is a common surgical approach.
- Recoarctation and late hypertension are significant post-operative concerns.
Purpose of the Study:
- To evaluate the outcomes of isolated aortic coarctation repair in children using left-side thoracotomy.
- To assess early and long-term complications, including mortality, morbidity, recoarctation, and hypertension.
Main Methods:
- Retrospective analysis of 90 pediatric patients undergoing resection and extended end-to-end anastomosis for isolated aortic coarctation.
- Review of preoperative characteristics, operative data, and postoperative follow-up results.
- Mean follow-up duration of 41.3 months.
Main Results:
- Low early mortality (1.1%) and reoperation rates (2.2%).
- Eight patients (8.8%) developed recoarctation, requiring reintervention in 4.4%.
- 26.8% of patients required antihypertensive treatment, with no late mortality.
Conclusions:
- Left-side thoracotomy resection with extended end-to-end anastomosis is an effective treatment for isolated coarctation.
- The procedure demonstrates low mortality, morbidity, and long-term recoarctation rates.
- Continuous long-term follow-up is essential to monitor for recoarctation and hypertension.
Introduction:
Isolated aortic coarctation performed through a left thoracotomy resection and end-to-end anastomosis results in low mortality and morbidity rates. Recoarctation and late hypertension are among the most important complications after such repairs. In this study, we reviewed the results of children who underwent left-side thoracotomy to correct an isolated aortic coarctation.
Method:
A consecutive sample of 90 patients who underwent resection and extended end-to-end anastomosis through a left-side thoracotomy in our centre between 2011 and 2021 was retrospectively analysed. The patients' preoperative characteristics, operative data, and post-operative early and long-term results were examined.
Results:
All patients underwent resection and extended end-to-end anastomosis. A pulmonary artery band was applied simultaneously to three (3.3%) patients, and an aberrant right subclavian artery division was applied to one (1.1%) patient. The mean cross-clamp time was 29.13 ± 6.97 minutes. Two (2.2%) patients required reoperation in the early period. Mortality was observed in one (1.1%) patient in the early period. Eight (8.8%) patients developed recoarctation, of whom four (4.4%) underwent reoperation and four (4.4%) underwent balloon angioplasty. Twenty-two (26.8%) patients received follow-up antihypertensive treatment. The mean follow-up period was 41.3 ± 22.8 months. No mortality was observed in the late period.
Conclusion:
Isolated coarctation is successfully treated with left-side thoracotomy resection and an extended end-to-end anastomosis technique with low mortality, morbidity, and low long-term recoarctation rates. Long-term follow-up is required due to the risks of early and late post-operative recoarctation, which requires reintervention.
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