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Repair of coarctation with resection and extended end-to-end anastomosis
C L Backer1, C Mavroudis, E A Zias
1Children's Memorial Hospital, and Department of Surgery, Northwestern University Medical School, Chicago, Illinois 60614, USA. c-backer@nwu.edu
Insights
Resection with extended end-to-end anastomosis is a safe and effective surgical strategy for infant coarctation, demonstrating low mortality and recoarctation rates. This method is now the preferred choice for treating coarctation of the aorta in infants.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Aortic Arch Reconstruction
Background:
- Surgical strategies for infant coarctation evolved in 1991.
- Shift from subclavian flap aortoplasty to resection with extended end-to-end anastomosis.
- This review evaluates the outcomes of the newer surgical approach.
Purpose of the Study:
- To assess the efficacy of resection with extended end-to-end anastomosis for infant coarctation repair.
- To determine the mortality and recoarctation rates associated with this surgical technique.
- To compare outcomes with previous surgical methods.
Main Methods:
- Retrospective review of 55 infants undergoing coarctation repair from 1991-1997.
- Analysis of patient demographics, associated cardiac lesions, and surgical approaches (thoracotomy vs. sternotomy).
- Detailed description of the resection and extended end-to-end anastomosis technique.
Main Results:
- One early death and two late deaths occurred, with no instances of paraplegia.
- Follow-up ranged from 10 to 76 months (mean 39.8 months).
- Two patients developed recoarctation, successfully treated with balloon dilation, resulting in a 3.6% recoarctation rate.
Conclusions:
- Resection with extended end-to-end anastomosis offers low mortality and a significantly low recoarctation rate.
- This technique is a reliable and preferred surgical option for infant coarctation of the aorta.
- The study supports the continued use of this approach for improved patient outcomes.
Background:
Our surgical strategy for infant coarctation changed from subclavian flap aortoplasty to resection with extended end-to-end anastomosis in 1991. The purpose of this review was to evaluate the results of that strategy.
Methods:
From 1991 through 1997, 55 infants underwent repair of coarctation of the aorta using resection with extended end-to-end anastomosis. Isolated coarctation of the aorta was present in 26 patients, 20 patients had a ventricular septal defect, and 9 patients had other associated intracardiac lesions. Mean age at surgery was 0.20+/-0.24 years (median, 21 days). In 34 patients (62%), arch reconstruction was performed through a left thoracotomy. Twenty patients (36%) had median sternotomy with simultaneous repair of coarctation of the aorta and intracardiac repair of associated lesions. One patient had recoarctation repair through a median sternotomy. All coarctation and ductal tissue was resected and the anastomosis was constructed starting opposite the left carotid artery with running polypropylene suture.
Results:
There was one early death 26 days after coarctation of the aorta and ventricular septal defect repair in a child on extracorporeal membrane oxygenation for meconium aspiration and 2 late deaths owing to pneumonia and pulmonary hypertension (1) and interventricular hemorrhage (1). There were no instances of paraplegia. Follow-up in survivors ranges from 10 to 76 months (mean, 39.8+/-17.2 months). Recoarctation has developed in 2 patients, who have had successful balloon dilation 6 and 14 months after the operation. This yields a low recoarctation rate of 3.6%.
Conclusions:
Resection with extended end-to-end anastomosis yields a low mortality and particularly a low recoarctation rate and is our procedure of choice for infants with coarctation of the aorta.