Aortoplasty compared with resection for coarctation of the aorta in young children

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Defects
• Vascular Surgery

Background:

• Coarctation of the aorta is a critical congenital heart defect requiring surgical intervention in infants and children.
• Surgical repair methods include resection with end-to-end anastomosis and patch graft aortoplasty.
• Optimal surgical strategy for complex coarctation in very young children remains a subject of investigation.

Purpose of the Study:

• To compare the efficacy of resection with end-to-end anastomosis versus patch graft aortoplasty in repairing coarctation of the aorta in children under 3 years old.
• To evaluate postoperative hemodynamic outcomes, specifically brachial artery systolic pressure and pressure gradient across the aorta (delta PA0).

Main Methods:

• Retrospective analysis of 18 pediatric patients (<3 years) undergoing coarctation repair.
• Group 1: Resection with end-to-end anastomosis (8 patients).
• Group 2: Patch graft aortoplasty (10 patients).
• Preoperative and postoperative hemodynamic data, including delta PA0, were compared between groups.

Main Results:

• Early postoperative mortality occurred in 3 patients (<2 months old).
• Survivors in Group 1 (resection) had significantly higher right brachial artery systolic pressure (133.1 mmHg) compared to Group 2 (patch graft aortoplasty) (102.5 mmHg).
• Delta PA0 was significantly higher in Group 1 (33.0 mmHg) than in Group 2 (5.1 mmHg).
• Three patients in Group 1 required reoperation with patch graft aortoplasty, achieving complete relief of delta PA0 in two.

Conclusions:

• Patch graft aortoplasty is superior to resection with end-to-end anastomosis in reducing postoperative aortic pressure gradients in infants and small children with coarctation of the aorta.
• Patch graft aortoplasty demonstrates better hemodynamic results and may reduce the need for reoperation compared to the resection technique in this pediatric population.