Coarctation repair through left thoracotomy in neonates and infants

Aim. A growing interest in the use of sternotomy and perfusion for repair of aortic coarctation in neonates and infants has enabled us to retrospectively review our own experience in this practice. Our purpose was to determine the efficacy of coarctation repair with extended end-to-end anastomosis through left thoracotomy focusing on a re-intervention rate and dynamics of transverse aortic arch growth during long-term follow-up. Methods. One hundred and twenty-four patients under 3 months old who underwent coarctation repair (between 2008 and 2016) were enrolled in this study. In 43 patients (35%), aorta coarctation was combined with ventricular septal defect, 49 patients (39.5%) had transversal aortic arch hypoplasia (Z-score less than –2). All operations were carried out by using extended “end-to-end” anastomosis technique via thoracotomy. In patients with concomitant ventricular septal defect, PA-banding was performed simultaneously. Overall follow-up was 3.6 (0.3–8.0) years. Results. Early mortality was 1.6%. Late survival rate was 93.5%. Recurrent aortic arch obstruction was revealed in 10 (8%) patients, on the average, in 6.5 (3.5–15) months after coarctation repair. Management of re-stenosis with balloon aortoplasty was effective in all cases and had no complications. A statistically significant growth (p<0.001) of the transverse aortic arch was observed in those patients who had hypoplasia of the arch before surgery. Conclusion. Repair of coarctation of the aorta by resection and extended “end-to-end” anastomosis via thoracotomy without perfusion has low operative mortality, an excellent survival rate and a reduced rate of balloon re-intervention. Patients with baseline moderate transverse aortic arch hypoplasia demonstrate a growth of the aorta up to normal values in long-term follow-up. Endovascular balloon dilatation of aortic re-coarctation zone during long-term follow-up is an effective and safe procedure. Received 20 June 2018. Revised 5 September 2018. Accepted 12 September 2018. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributions Conception and study design: V.N. Ilyin Data collection and analysis: M.M. Belyaeva, O.Yu. Kornoukhov, Yu.Yu. Kornoukhov, O.I. Kalinina Drafting the article: M.M. Belyaeva Critical revision of the article: V.N. Ilyin, O.Yu. Kornoukhov Final approval of the version to be published: M.M. Belyaeva, V.N. Ilyin, O.Yu. Kornoukhov, Yu.Yu. Kornoukhov, O.I. Kalinina

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Reconstruction of the Aortic Arch in Newborns and Infants Using an Extended End-to-End Anastomosis

Ukrainian journal of cardiovascular surgery ◽

10.30702/ujcvs/21.4409/t.d.039-63-68 ◽

2021 ◽

pp. 63-68

Author(s):

Iaroslav P. Truba ◽

Ivan V. Dziuryi ◽

Roman I. Sekelyk ◽

Oleksandr S. Golovenko

Keyword(s):

Hospital Mortality ◽

Aortic Arch ◽

Median Sternotomy ◽

Term Survival ◽

Long Term Survival ◽

The Mean ◽

End To End ◽

Aortic Arch Hypoplasia

The problem of the effectiveness of obstruction at the level of the aortic arch is still a matter of discus-sion in the modern literature. Traditionally, by excision of the coarctation part, in the presence of hypoplasia, the incision is extended to a narrowed area and a modification of the classical end-to-end anastomosis is applied in the form of an elongated or expanded variant. Recently, when proximal part is involved in the pathological process, cardiac surgeons have been more likely to use median sternotomy using other types of plastic surgery, including dilation of the narrowed area with a pericardial patch, or pulmonary artery tissue. Accordingly, the analysis of the results of the use of end-to-end anastomosis in young children with aortic arch hypoplasia, especially in view of long-term survival and the level of reoperation, is an important issue of neonatal cardiac surgery. The aim. To evaluate the effectiveness of the use of an extended end-to-end anastomosis after reconstruction of the aortic arch in children under 1 year of age. Materials and methods. The study material included 348 infants who underwent surgical correction of aortic arch hypoplasia through the method of extended end-to-end anastomosis from 2010 to 2020. The operations were performed at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine and the Ukrainian Children’s Cardiac Center. The study group included only patients with two-ventricular physiology. There were 233 male patients (67%) and 115 female patients (33%). The mean age was 1.07 (0.20; 2.30) months, the mean weight was 3.89 (3.30; 4.90) kg, the mean body surface area was 0.23 (0.20; 0.28) m2. Diagnosis of aortic arch hypoplasia was based on two-dimensional echocardiography. Results. According to echocardiography, after surgery there was a significant decrease in the pressure gradient in the aortic arch from 48.3 ± 20.3 to 16 ± 6.9 (p<0.05), left ventricular PV increased significantly from 61.6 ± 12% to 66.3 ± 6.4% (p> 0.05). The hospital mortality was 1.7% (n = 6). The causes of mortality were not related to the end-to-end aortic arch technique. The duration of follow-up period ranged from 1 month to 9.3 years. Two deaths occurred in the follow-up period. Thirty-two (9.1%) patients developed aortic arch restenosis in the postoperative period. Balloon dilatation of restenosis was performed in 21 patients. Eleven patients underwent repeated aortic arch repair surgery through the median sternotomy. There were no central nervous system complications in the follow-up period. Conclusions. The use of an extended end-to-end anastomosis in the surgical treatment of aortic arch hypoplasia demon strates low hospital mortality and high long-term survival. Indications for the effective use of this type of reconstruction are hypoplasia of the isthmus and distal aortic arch.

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Noninvasive long-term follow-up after coarctation repair

The Annals of Thoracic Surgery ◽

10.1016/0003-4975(93)90024-c ◽

1993 ◽

Vol 55 (5) ◽

pp. 1153-1159 ◽

Cited By ~ 25

Author(s):

Pieter A. Kappetein ◽

Gerard L. Guit ◽

Ad J.J.C. Bogers ◽

Hans W. Weeda ◽

Koos H. Zwinderman ◽

...

Keyword(s):

Coarctation Repair ◽

Long Term Follow Up

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Long-term follow-up of the Starflex device for closure of secundum atrial septal defect

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.21956 ◽

2009 ◽

Vol 73 (2) ◽

pp. 196-196 ◽

Cited By ~ 2

Author(s):

Jonathan Tobis

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Secundum Atrial Septal Defect ◽

Long Term Follow Up

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Contemporary outcomes of aortic arch hypoplasia and coarctation repair in a tertiary paediatric cardiac surgery centre

Cardiology in the Young ◽

10.1017/s1047951121003747 ◽

2021 ◽

pp. 1-6

Author(s):

Amr Ashry ◽

Amer Harky ◽

Abdulla Tarmahomed ◽

Christopher Ugwu ◽

Heba M. Mohammed ◽

...

Keyword(s):

Aortic Arch ◽

Circulatory Arrest ◽

Recurrent Laryngeal Nerve Injury ◽

Coarctation Repair ◽

Aortic Arch Reconstruction ◽

Retrospective Data Collection ◽

Laryngeal Nerve Injury ◽

Neonates And Infants ◽

Arch Reconstruction ◽

Aortic Arch Hypoplasia

Abstract Objectives: There are several studies reporting the outcomes of hypoplastic aortic arch and aortic coarctation repair with combination of techniques. However, only few studies reported of aortic arch and coarctation repair using a homograft patch through sternotomy and circulatory arrest with retrograde cerebral perfusion. We report our experience and outcomes of this cohort of neonates and infants. Methods: We performed retrospective data collection for all neonates and infants who underwent aortic arch reconstruction between 2015 and 2020 at our institute. Data are presented as median and inter-quartile range (IQR). Results: The cohort included 76 patients: 49 were males (64.5%). Median age at operation was 16 days (IQR 9–43.25 days). Median weight was 3.5 kg (IQR 3.10–4 kg). There was no 30 days mortality. Three patients died in hospital after 30 days (3.95%), neurological adverse events occurred in only one patient (1.32%) and recurrent laryngeal nerve injury was noted in four patients (5.26%). Only three patients required the support of extracorporeal membrane oxygenation (ECMO) with a median ECMO run of 4 days. Median follow-up was 35 months (IQR 18.9–46.4 months); 5 years survival was 93.42% (n = 71). The rate of re-intervention on the aortic arch was 9.21% (n = 7). Conclusion: Our experience shows excellent outcomes in repairing aortic arch hypoplasia with homograft patch under moderate to deep hypothermia with low in-hospital and 5 years mortality rates.

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Early and late outcomes of surgical repair of double-chambered right ventricle: a single-centre experience

Cardiology in the Young ◽

10.1017/s1047951120000244 ◽

2020 ◽

Vol 30 (3) ◽

pp. 409-412

Author(s):

Murat Surucu ◽

İlkay Erdoğan ◽

Birgül Varan ◽

Murat Özkan ◽

N. Kürşad Tokel ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Right Ventricle ◽

Septal Defect ◽

Surgical Intervention ◽

Systolic Pressure ◽

Presenting Symptoms ◽

Long Term Follow Up ◽

The Right

AbstractObjective:Double-chambered right ventricle is characterised by division of the outlet portion of the right ventricle by hypertrophy of the septoparietal trabeculations into two parts. We aim to report our experiences regarding the presenting symptoms of double-chambered right ventricle, long-term prognosis, including the recurrence rate and incidence of arrhythmias after surgery.Methods:We retrospectively investigated 89 consecutive patients who were diagnosed to have double-chambered right ventricle and underwent a surgical intervention from 1995 to 2016. The data obtained by echocardiography, cardiac catheterisation, and surgical findings as well as post-operative follow-up, surgical approaches, post-operative morbidity, mortality, and cardiac events were evaluated.Results:Median age at the time of diagnosis was 2 months and mean age at the time of operation was 5.3 years. Concomitant cardiac anomalies were as follows: perimembranous ventricular septal defect (78 patients), atrial septal defect (9 patients), discrete subaortic membrane (32 patients), right aortic arch (3 patients), aortic valve prolapse and/or mild aortic regurgitation (14 patients), and left superior caval vein (2 patients). The mean follow-up period was 4.86 ± 4.6 years. In these patients, mean systolic pressure gradient in the right ventricle by echocardiography before, immediately, and long-term after surgical intervention was 66.3, 11.8, and 10.4 mmHg, respectively. There were no deaths during the long-term follow-up period. Surgical reinterventions were performed for residual ventricular septal defect (2), residual pulmonary stenosis (1), and severe tricuspid insufficiency (1).Conclusion:The surgical outcomes and prognosis of double-chambered right ventricle are favourable, recurrence and fatal arrhythmias are unlikely in long-term follow-up.

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