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Correction of aortic coarctation in neonates: mortality and late results
Insights
Infants undergoing aortic coarctation repair before 90 days face high mortality but aggressive surgery can yield excellent long-term results for survivors. Early repair of associated anomalies may improve survival rates.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Neonatal Cardiology
Background:
- Aortic coarctation is a critical congenital heart defect requiring early intervention.
- Infants undergoing repair at less than 90 days of age present unique surgical challenges.
- Associated anomalies frequently complicate coarctation repair and impact outcomes.
Purpose of the Study:
- To identify factors influencing mortality in infants undergoing aortic coarctation repair.
- To evaluate the long-term results and survival after surgical repair in this high-risk group.
- To assess the impact of associated anomalies and subsequent interventions on patient outcomes.
Main Methods:
- Retrospective review of 44 infants undergoing aortic coarctation repair before 90 days of age.
- Analysis of operative and late mortality, including causes and timing.
- Assessment of long-term outcomes in survivors, including need for reoperation and functional status.
Main Results:
- High mortality observed: 14 operative deaths and 8 late deaths (mean 4.3 months postoperatively).
- 20 patients (45%) required 22 subsequent operations for associated anomalies, contributing to mortality.
- Among 17 survivors with sufficient data, 8 had excellent, 4 fair, and 5 poor long-term outcomes.
Conclusions:
- Aggressive surgical management is warranted for infants with aortic coarctation despite high early mortality.
- Early repair of associated anomalies may be crucial for improving overall survival.
- A significant proportion of infants can achieve excellent long-term results with timely and comprehensive surgical intervention.
Abstract:
To determine those factors that affect mortality and to analyze long-term results, the records of 44 infants who underwent repair of aortic coarctation at less than 90 days of age were examined. There were 14 operative and 8 late deathes (mean, 4.3 months postoperatively). Subsequent operation, generally to repair or palliate associated anomalies, was required 22 times in 20 patients and was a source of considerable mortality. There is evidence that earlier total repair of associated anomalies might improve survival. Sufficient data were available on 17 of the 22 survivors to assess long-term results. The outcome was considered excellent in 8 patients, fair in 4, and poor in 5. Revision of the coarctation repair due to growth failure of the anastomosis was required in 1 patient. Aggressive surgical management is recommended in these infants because, despite a high early mortality, a considerable proportion of excellent results can be anticipated in what is otherwise a hopeless situation.