Repair of neonatal aortic coarctation
1Department of Cardiovascular Surgery, Children's Hospital and Medical Center, Seattle, WA 98105, USA.
Insights
Infants undergoing aortic coarctation repair had an 11% mortality rate, particularly those with renal failure. Left subclavian artery flap angioplasty was the primary repair method, with an 11% restenosis rate.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Aortic Coarctation Repair
Background:
- Aortic coarctation is a critical congenital heart defect requiring surgical intervention in neonates.
- Congestive heart failure is the primary presentation in infants with aortic coarctation.
- Surgical outcomes for aortic coarctation vary based on defect complexity and patient comorbidities.
Purpose of the Study:
- To evaluate the outcomes of aortic coarctation repair in infants.
- To assess the efficacy of different surgical techniques, including left subclavian artery flap angioplasty.
- To identify factors associated with hospital mortality and restenosis.
Main Methods:
- Retrospective review of 146 infants under 1 month undergoing aortic coarctation repair (1981-1991).
- Categorization of patients into isolated coarctation, coarctation with ventricular septal defect, and complex cardiac defects.
- Analysis of surgical techniques (left subclavian artery flap angioplasty, end-to-end anastomosis), concomitant procedures (pulmonary artery banding), and clinical outcomes.
Main Results:
- Overall hospital mortality was 11%, significantly associated with pre-existing renal failure.
- Left subclavian artery flap angioplasty was performed in 126 infants, with a 10% incidence of significant restenosis.
- Mean hospital stay for survivors was 13.4 days; 11 patients required reoperation, and 5 were managed with balloon dilatation.
Conclusions:
- Surgical repair of aortic coarctation in neonates carries a significant mortality risk, particularly in those with renal compromise.
- Left subclavian artery flap angioplasty is an effective repair technique but has a notable restenosis rate.
- Long-term management may involve reoperation or balloon angioplasty for restenosis.
Abstract:
From 1981 to 1991, 146 infants under 1 month of age underwent repair of aortic coarctation. Forty-two had isolated coarctation, 53 had associated ventricular septal defect, and 51 had complex cardiac defects. The principal mode of presentation was congestive heart failure. The mean age at operation was 10.6 days. The technique for repair was left subclavian artery flap angioplasty in 126, resection with end-to-end anastomosis in 14, and a variety of repairs in 6 patients. Concomitant pulmonary artery banding was performed in 62 patients. The overall hospital mortality rate was 11%, and there was a strong association with pre-existing renal failure. The mean aortic clamp time in survivors was 23.9 minutes; mean hospital stay was 13.4 days. Significant restenosis occurred in 16 patients (11%) with an incidence of 10% after subclavian artery flap angioplasty. Eleven patients have undergone reoperation, and 5 were managed successfully with balloon dilatation.
