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Repair of aortic coarctation in infants: experience with an intraluminal shunt
Insights
Infant coarctation repair outcomes improved with prostaglandin E1 (PGE1), subclavian aortoplasty, and intraluminal shunts. These techniques reduced early mortality and long-term complications like arm-leg pressure gradients.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
Background:
- Coarctation of the aorta is a congenital heart defect requiring surgical repair in infants.
- Surgical techniques for coarctation repair have evolved over time, impacting patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of different surgical repair methods for coarctation of the aorta in infants.
- To identify factors contributing to improved outcomes in infant coarctation repair.
Main Methods:
- Retrospective review of 63 infants undergoing coarctation repair between 1962 and mid-1984.
- Analysis of surgical techniques including subclavian aortoplasty, end-to-end anastomosis, and use of intraluminal shunts.
- Inclusion of prostaglandin E1 (PGE1) infusion in some patients.
Main Results:
- Overall early mortality was 16% (10 patients), with higher rates for end-to-end anastomosis compared to subclavian aortoplasty.
- No early deaths occurred in 15 patients who underwent subclavian aortoplasty with an intraluminal shunt.
- No arm-leg pressure gradients were observed in patients treated with subclavian aortoplasty, unlike those with end-to-end anastomosis.
Conclusions:
- Subclavian aortoplasty with an intraluminal shunt demonstrated superior early outcomes compared to end-to-end anastomosis.
- The use of prostaglandin E1 (PGE1), subclavian aortoplasty, and intraluminal shunts were associated with improved results in infant coarctation repair.
Abstract:
From 1962 to mid-1984, 63 infants underwent coarctation repair. Cardiac defects were present in 46 (73%). Repair was by subclavian aortoplasty in 35 patients, resection and end-to-end anastomosis in 19, and other techniques in 6. Three patients died before the repair was completed. In 15 patients, an intraluminal shunt was used during subclavian aortoplasty. Prostaglandin E1 (PGE1) was infused in 9 patients. Early (thirty-day) mortality was 16% (10 patients): 4 patients who underwent end-to-end anastomosis; 3 during attempted end-to-end anastomosis; 2 who received bypass grafts; and 1 who had subclavian aortoplasty without a shunt. None of the 15 patients who had subclavian aortoplasty with a shunt died. There were no early deaths among the last 25 patients seen. One patient who underwent subclavian aortoplasty without a shunt is paraplegic. There were 10 late deaths among the 53 patients followed from 1 month to 12 years (mean, 3 years). Arm-leg pressure gradients of 20 mm Hg or greater were found in 4 of the patients who had end-to-end anastomosis but not in any of the patients who had subclavian aortoplasty. Improved results of coarctation repair in infants in this study were attributed to PGE1, subclavian aortoplasty, and use of an intraluminal shunt.