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Comparative analysis of the effectiveness of coarctation surgery between neonates and infants
Mustafa Yilmaz1, Başak Soran Turkcan1, Ata Niyazi Ecevit1
1Ankara Bilkent City Hospital, Department of Pediatric Cardiovascular Surgery - Ankara, Turkey.
Insights
Resection and extended end-to-end anastomosis effectively repairs coarctation in neonates and infants, significantly reducing gradients and enlarging aortic arch segments. This technique shows equal effectiveness across both age groups for aortic coarctation treatment.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Vascular Surgery
Background:
- Coarctation of the aorta is a significant congenital heart defect requiring surgical intervention.
- The choice of surgical technique for coarctation repair in neonates versus infants is critical for long-term outcomes.
- Resection and extended end-to-end anastomosis is a common surgical approach for aortic coarctation.
Purpose of the Study:
- To compare the effectiveness of resection and extended end-to-end anastomosis in neonates versus infants with coarctation of the aorta.
- To evaluate the impact of preoperative factors on postoperative outcomes.
- To assess early postoperative results including residual gradient, re-intervention rates, and mortality.
Main Methods:
- Retrospective study of 41 neonate and infant patients undergoing resection and extended end-to-end anastomosis for aortic coarctation.
- Analysis of preoperative aortic annulus and arch diameters (Z scores), hypoplastic segments, and prematurity.
- Investigation of relationships between preoperative parameters and residual gradient, need for re-intervention, and early mortality.
Main Results:
- Neonate group had significantly lower mean age, body weight, and proximal arch Z score compared to infants.
- Neonate group experienced significantly longer intensive care unit and hospital stays.
- Significant enlargement of proximal arch, distal arch, and isthmus segments was observed in both groups postoperatively.
Conclusions:
- Resection and extended end-to-end anastomosis is an effective technique for aortic coarctation repair in both neonates and infants.
- The procedure leads to a marked decrease in the coarctation gradient and significant aortic arch enlargement.
- The technique demonstrates comparable effectiveness in neonates and infants during the early postoperative period.
Objective:
This study aimed to compare the effectiveness of resection and extended end-to-end anastomosis between neonate and infant patients with coarctation.
Methods:
This study was designed retrospectively and included 41 neonate (<30 days) and infant (30 days to 1 year) patients who were operated on using the resection and extended end-to-end anastomosis technique for aortic coarctation. Preoperative aortic annulus diameters and Z scores, all aortic arch diameters and Z scores, the presence of hypoplastic aortic segment, and the presence of prematurity were reviewed in both groups. Subsequently, we investigated whether these parameters were statistically related to the residual gradient in the operation area, whether there was a need for early re-intervention, and what was the incidence of mortality in the early postoperative period. In addition, the aortic arch Z scores of the patients at 6 months postoperatively were examined.
Results:
While the mean age (p<0.001), body weight (p<0.001), and proximal arch Z score (p=0.029) were found to be significantly lower in the neonate group than in the infant group, the total length of the intensive care unit stay (p=0.013) and the total length of hospital stay (p=0.017) were found to be significantly higher. In addition, significant enlargement was detected in the proximal arch, distal arch, and isthmus segments in both patient groups.
Conclusion:
The resection and extended end-to-end anastomosis is an equally effective technique that can provide a marked decrease in gradient in the coarctation area and a significant enlargement of the aortic arch segments in the early period after coarctation repair in both neonate and infant patients.
