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Published on: March 26, 2018
Comparison of Sternotomy Access Versus Thoracotomy Access in the Surgical Treatment of Aortic Coarctation: A
Ilya A Soynov1, Ksenya A Rzayeva1, Yuriy N Gorbatykh1
1Federal State Budgetary Institution, Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Russia.
Insights
Sternotomy and thoracotomy approaches for aortic coarctation repair showed similar mortality and complication rates. However, sternotomy may reduce the recurrence of aortic coarctation.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiac Surgery
- Thoracic Surgery
Background:
- Surgical repair of aortic coarctation aims to prevent recoarctation and hypertension.
- No consensus exists on the optimal surgical approach for aortic coarctation.
- Hypoplasia of the distal aortic arch is a common challenge in aortic coarctation repair.
Purpose of the Study:
- To compare sternotomy and left thoracotomy for aortic coarctation repair.
- To evaluate surgical techniques in patients with aortic coarctation and distal aortic arch hypoplasia.
Main Methods:
- 103 patients underwent extended oblique anastomosis between 2008 and 2020.
- Patients were divided into thoracotomy (n=68) and sternotomy (n=35) groups.
- Propensity score analysis matched 25 patients from each group for comparison.
Main Results:
- Mortality rates were 4% for thoracotomy and 8% for sternotomy (p > 0.99).
- No significant differences in early postoperative complications were observed.
- Aortic recoarctation recurrence was higher in the thoracotomy group (20.8% vs 0%).
Conclusions:
- Both sternotomy and thoracotomy offer comparable mortality and early complication rates for aortic coarctation repair.
- The sternotomy approach may be advantageous in minimizing aortic recoarctation.
- Low patient weight is a risk factor for aortic re-coarctation.
Background:
The search for the "Holy Grail" of surgical repair for aortic coarctation involves finding an access and correction method that successfully and consistently avoids aortic recoarctation and arterial hypertension. The controversy persists as there is still no consensus on the best surgical approach and technique to achieve these objectives.
Objective:
The objective of this study is to compare sternotomy and left thoracotomy as surgical techniques for treating patients with aortic coarctation and hypoplasia of the distal aortic arch.
Methods:
From January 2008 to December 2020, 103 surgical procedures were performed using an extended oblique anastomosis. The patients were divided into 2 groups: oblique, extended anastomosis from thoracotomy access (n-68; 66%) and oblique extended anastomosis from sternotomy access (n-35; 34%). After performing a propensity score analysis (1:1) for the entire sample, 25 patients from sternotomy access were matched with 25 patients from thoracotomy access.
Results:
The mortality rate in the thoracotomy group was 4%, with 1 patient, while it was 8% with 2 patients in the sternotomy group, p > 0.99. There were no significant differences in early postoperative complications between the two groups. Recurrence of aortic coarctation was observed more frequently in the thoracotomy group (20.8% vs 0%). Low weight was identified as the only risk factor for aortic re-coarctation.
Conclusion:
The mortality rates and early postoperative complications associated with the surgical repair of aortic coarctation were similar between the sternotomy and thoracotomy approaches. Nevertheless, sternotomy approach may be beneficial in reducing aortic recoarctation.
