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Non-absorbable running suture in coarctation repair in infants: a cross-sectional study
Opas Satdhabudha1, Manita Songvasin2, Utairat Chaumrattanakul3
1Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand. opascts@hotmail.com.
Insights
Continuous nonabsorbable sutures for infant coarctation repair promote aortic growth. Surgical reintervention revealed suture lines did not correlate with recoarctation sites.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Vascular Surgery
Background:
- Coarctation of the aorta repair in newborns and infants often utilizes continuous nonabsorbable (polypropylene) sutures for aortic anastomosis.
- This study investigates the growth of the anastomosis site and its relationship with recoarctation in patients requiring reintervention.
Purpose of the Study:
- To evaluate the growth of the aortic anastomosis site after repair of coarctation of the aorta in infants using continuous nonabsorbable sutures.
- To determine the correlation between anastomosis site growth and the occurrence of recoarctation necessitating surgical reintervention.
Main Methods:
- A cross-sectional survey included patients who underwent aortic anastomosis for symptomatic coarctation within their first year of life (2008-2023).
- Computed tomography angiography (CTA) was used to assess aortic arch diameters and calculate z-scores.
- Surgical pathology of patients requiring reintervention for recurrent stenosis was reviewed.
Main Results:
- Fifteen patients underwent CTA, with a median follow-up of 8.08 years.
- Median z-scores for the repaired distal transverse arch and descending aorta at anastomosis were -0.08 and 1.13, respectively.
- No significant difference in z-scores was observed between patients with and without aortic arch hypoplasia. One case of restenosis showed suture line misalignment with the narrowest segment.
Conclusions:
- Continuous nonabsorbable sutures facilitate normal growth of the aortic arch and anastomosis site in infant coarctation repair, irrespective of aortic arch hypoplasia.
- Pathological findings suggest that the suture line does not necessarily correspond to the area of maximal narrowing in cases of restenosis.
Background:
In our institute, resection and aortic anastomosis for newborns and infants with coarctation of the aorta are typically performed using continuous nonabsorbable (polypropylene) sutures. This cross-sectional survey aims to examine the anastomosis site, focusing on the prevalence of growth and its correlation with recoarctation in cases requiring surgical reintervention.
Methods:
Patients who underwent aortic anastomosis for symptomatic coarctation during their first year of life between 2008 and 2023 and were still alive were included in the study for evaluation. Aortic arch diameters were assessed using computed tomography angiography (CTA), and z-scores were calculated. For patients with recurrent stenosis who required subsequent surgery, the surgical pathology was reviewed.
Results:
A total of 15 patients underwent CTA assessment, with a median time from surgery to CTA of 8.08 years (4.39, 10.02). The z-scores for the diameters at the repaired areas were as follows: for the distal transverse arch, the median z-score was - 0.08 (-0.52, 0.59), and for the descending aorta at the anastomosis, it was 1.13 (0.18, 1.72). When comparing the two subgroups-7 patients with aortic arch hypoplasia and 8 without-no significant differences were found in the z-scores of the diameters at the repaired sites. In one case of restenosis at the 4-year follow-up, subsequent surgery revealed that the suture line did not align with the narrowest segment.
Conclusions:
Using continuous non-absorbable suture for aortic anastomosis in coarctation repair for newborns and infants can result in the growth of the aortic arch and the anastomosis site reaching the normal range, regardless of the presence of aortic arch hypoplasia. Pathological findings from a surgical reintervention indicate that the aortic wall segment containing suture material does not align with the area exhibiting the greatest narrowing.
Trial Registration:
Trial registration number (Study ID): TCTR20240412007.
