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[Surgical treatment of critical aortic isthmus stenosis in infancy]
Insights
Infants with coarctation of the aorta and heart defects face high surgical risk, especially if under three months old. The subclavian flap technique is recommended for preductal coarctation.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Aortic Coarctation Repair
Context:
- Surgical outcomes for coarctation of the aorta (CoA) in infants are critical.
- Early surgical intervention is often necessary for severe CoA cases.
- Associated cardiac anomalies significantly impact surgical risk and outcomes.
Purpose:
- To report early and late results of surgical repair for coarctation of the aorta in infants.
- To evaluate the effectiveness of different surgical methods, including the Waldhausen subclavian flap, resection and end-to-end anastomosis, Clagett method, and Goretex patch.
- To identify risk factors influencing mortality and morbidity in infant CoA repair.
Summary:
- This study analyzed 43 infants undergoing surgical repair for coarctation of the aorta between 1970-1982.
- Early mortality was 39.5%, predominantly in infants under 3 months with severe associated cardiac anomalies.
- Late restenosis occurred in 6 of 24 survivors, with varying rates among different surgical techniques. The subclavian flap method showed a 20% restenosis rate.
- Infants under 3 months with associated cardiac anomalies present a higher surgical risk.
- The subclavian flap technique is suggested as the preferred method for preductal coarctation.
Impact:
- Results highlight the increased surgical risk for infants under three months with complex cardiac anomalies.
- Identifies the subclavian flap technique as a potentially superior method for preductal coarctation, with lower restenosis rates compared to end-to-end anastomosis.
- Provides valuable long-term data on surgical outcomes for coarctation of the aorta in a pediatric population.
Abstract:
Early and late results of 43 infants (35 under 3 months of age) who underwent different surgical repairs (29 Waldhausen subclavian flap method, 11 resection and end-to-end-anastomosis, 1 Clagett method, 2 Goretex patch) for coarctation of the aorta during the years 1970-1982 are reported. Only one patient had isolated coarctation, five patients had coarctation with patent duct (PDA). Associated cardiac anomalies were found in 37 patients. 17 (39,5%) infants died early after surgery. All were under 3 month of age with severe cardiac anomalies (16x intracardiac, 1x PDA). There were two late deaths after correction of intracardiac defects. In 6 out of 24 surviving patients restenosis developed 1-10 years after repair (3 of 6 patients with end-to-end-anastomosis = 50%, 2 of 10 patients with subclavian flap method = 20%, 1 patient with Goretex-patch). Our results show that coarctation with associated cardiac anomalies in patients under 3 month present higher surgical risk. Subclavian flap technique ist the method of choice for preductal coarctation. Technical difficulties related of this method are discussed in detail.