End-to-side anastomosis and autologous pulmonary artery patch for aortic coarctation and hypoplastic aortic arch
Zhenjiang Zhao1, Chun Wu1, Jiangtao Dai1
1Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
Insights
Autologous pulmonary artery patch (APAP) repair for aortic coarctation (CoA) with hypoplastic aortic arch (HAA) is safe and effective. APAP reduces risks of abnormal aortic arch geometry, elevated blood pressure, and recoarctation compared to end-to-side anastomosis (ESA).
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease Research
Background:
- Aortic coarctation (CoA) is a congenital heart defect often associated with hypoplastic aortic arch (HAA).
- Surgical repair strategies for CoA with HAA require careful consideration to optimize outcomes.
- End-to-side anastomosis (ESA) and autologous pulmonary artery patch (APAP) are surgical techniques employed for these complex cases.
Purpose of the Study:
- To compare the clinical outcomes of end-to-side anastomosis (ESA) versus autologous pulmonary artery patch (APAP) in patients with aortic coarctation and hypoplastic aortic arch.
- To evaluate the safety and effectiveness of these surgical approaches in managing combined cardiovascular malformations.
- To provide additional clinical experience and data on surgical repair of CoA with HAA.
Main Methods:
- A single-center retrospective study of consecutive patients with aortic coarctation and HAA who underwent surgery between 2015 and 2021.
- Data collected included patient demographics, pre-operative measurements (constricted segment, pressure gradient via echocardiography and CT), and surgical technique.
- Patients were divided into two groups: ESA (n=59) and APAP (n=37). Statistical analysis, including Cox regression, was performed.
Main Results:
- Ninety-six patients were enrolled; 93 were followed up for a median of 46.20 months.
- Cox regression identified ESA as a risk factor for Gothic aortic arch geometry (G-AAg), elevated blood pressure (EBp), and aortic recoarctation (reCoA).
- The incidence of G-AAg, EBp, and reCoA was significantly higher in the ESA group (18, 13, and 12 patients, respectively) compared to the APAP group (3, 1, and 1 patient, respectively).
Conclusions:
- One-stage median sternotomy is a safe and effective approach for repairing CoA, HAA, and associated cardiovascular malformations.
- Autologous pulmonary artery patch (APAP) is associated with lower risks of G-AAg, EBp, and reCoA compared to ESA.
- Expanding indications for APAP, when feasible, is recommended to improve patient outcomes, potentially aided by selective antegrade cerebral perfusion.
Background:
Aortic coarctation (CoA) is a congenital heart disease that usually combines various cardiovascular malformations, including hypoplastic aortic arch (HAA). We explore end-to-side anastomosis (ESA) and autologous pulmonary artery patch (APAP) in CoA with HAA, to provide more clinical experience.
Methods:
This is a single-center retrospective study. The target population is patients with aortic stenosis and HAA who underwent surgery between 2015 and 2021. All cases included were consecutive, and no instances were omitted due to absent data, lack of consent, or other factors. Collect information on gender, age, and weight at the time of the operation, detailed information on the constricted segment and pressure gradient evaluated by echocardiography and computed tomography (CT), and other factors of patients, and these data were analyzed by statistical methods.
Results:
Ninety-six patients (67 males and 29 females) with median age of 76 (41.75, 128.50) days and median weight of 4.20 (3.70, 5.10) kg were enrolled. The follow-up period was 46.20 (34.40, 54.70) months. The patients were divided into two groups based on surgery: ESA (G1, 59) and APAP (G2, 37). The combined cardiovascular malformations were treated simultaneously. None of the patients had neurological events or renal failure, and three died early after the operation. Finally, 93 patients were successfully followed-up. Cox regression showed that ESA was a risk factor for aortic arch geometry is closer to Gothic (G-AAg), elevated blood pressure (EBp), and aortic recoarctation (reCoA) after surgery. In G1, 18 patients had G-AAg (P=0.03), 13 had EBp (P=0.041), and 12 had reCoA (P=0.041), all of which were significantly higher than those in G2 (three had G-AAg, one of whom had EBp and reCoA).
Conclusions:
It is safe and effective to repair CoA and HAA and other cardiovascular malformations through one-stage median sternotomy. Compared with ESA, APAP can lower the risks of G-AAg, EBp, and reCoA. Although APAP takes longer, the proper application of selective antegrade cerebral perfusion may lower the risks. We recommend expanding the indications for APAP when circumstances allow, which will benefit patients.
