Related Experiment Videos
Transsternal repair of coarctation and associated cardiac defects
S Y DeLeon1, F X Downey, N E Baumgartner
1Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL 60153.
Insights
Transsternal repair of coarctation in 20 infants and children showed a 5% early mortality and no late deaths. Recurrent coarctation occurred in two patients, highlighting the need for precise surgical techniques.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Thoracic Surgery
Background:
- Coarctation of the aorta is a critical congenital heart defect often requiring surgical intervention.
- Associated cardiac defects, such as intracardiac shunts and valvular issues, complicate repair and outcomes.
- The transsternal approach is a common surgical method for addressing coarctation in pediatric patients.
Purpose of the Study:
- To evaluate the outcomes of transsternal repair for coarctation of the aorta and associated cardiac defects in infants and children.
- To analyze the different surgical techniques employed and their impact on patient results.
- To identify risk factors and complications associated with this surgical approach.
Main Methods:
- A retrospective review of 20 infants and children who underwent transsternal repair for coarctation and associated defects over 13 years.
- Classification of patients into groups based on intracardiac shunts versus obstruction/valvular insufficiency.
- Detailed analysis of surgical repair types, including side patch aortoplasty, ductal tissue excision with patch aortoplasty, and subclavian aortoplasty.
Main Results:
- Fifteen of 20 patients (75%) were operated on in the last 6 years, indicating increased utilization.
- Group 1 (intracardiac shunts) had younger patients (mean age 0.8 years) compared to Group 2 (obstruction/valvular insufficiency, mean age 4 years).
- Aortic arch hypoplasia was noted in 6 patients, often associated with a patent ductus arteriosus (p=0.006). One patient required a bypass graft due to hypoplasia.
- One early death (5%) occurred due to sepsis in a newborn; no late deaths were observed during a mean follow-up of 4.3 years.
- Two patients experienced recurrent coarctation, one after end-to-end repair and another after incomplete arch enlargement.
Conclusions:
- Transsternal repair of coarctation with associated defects in pediatric patients can achieve good long-term outcomes with low mortality.
- Surgical technique selection, particularly for aortic arch hypoplasia, is critical to prevent complications like recurrent coarctation.
- Further research into optimizing surgical strategies for complex coarctation repairs is warranted.
Abstract:
Over a 13-year period, 20 infants and children underwent transsternal approach for repair of coarctation and associated cardiac defects. Fifteen patients (75%) were operated on in the last 6 years. Thirteen patients (group 1) had intracardiac shunts and 7 (group 2), intracardiac obstruction or valvular insufficiency. Group 1 had a mean age of 0.8 +/- 1.9 years versus 4 +/- 3 years for group 2 (p = 0.05). There were 12 patients (92%), 7 months old or less in group 1. Aortic arch hypoplasia was present in 6 patients in group 1. A large patent ductus arteriosus was present in 5 of these 6 patients versus no patent ductus arteriosus in patients without aortic arch hypoplasia (p = 0.006). The mean pulmonary blood flow to systemic blood flow ratio in group 1 was 3.8 +/- 2 and the mean right ventricular to left ventricular ratio, 0.8 +/- 0.2. The coarctation repair fell mostly into three types: side patch aortoplasty (8), ductal tissue excision and patch aortoplasty of the concavity of the aortic arch (6), and subclavian aortoplasty (4). There was one early death (5%) which was due to sepsis in a newborn. Another newborn who had subclavian aortoplasty needed a left carotid artery--descending aorta bypass conduit early because of aortic arch hypoplasia. All patients were followed to 12 years (mean follow-up, 4.3 +/- 3.5 years). There were no late deaths. Two patients had recurrent coarctation, 1 after an end-to-end repair and the other because of incomplete arch enlargement after a side patch aortoplasty.(ABSTRACT TRUNCATED AT 250 WORDS)