Surgical repair of aortic coarctation in pediatric age: A single center two decades experience
- 13 March 2019
- journal article
- research article
- Published by Hindawi Limited in Journal of Cardiac Surgery
- Vol. 34 (5), 256-265
- https://doi.org/10.1111/jocs.14019
Abstract
Background To evaluate early and long‐term results of surgical treatment of aortic coarctation (CoAo) in infants and children. Methods A retrospective clinical review of patients less than 18 years with CoAo, undergoing surgery between 1995 and 2015. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by bivariate, Cox's, and logistic regression analysis. Results Three hundred forty‐one consecutive patients (male/female: 192/149; the median age at surgery of 25 days; interquartile range [IQR], 10‐143 days) were included; 187 patients were less than 1 month (54.9%); 276 underwent extended end‐to‐end anastomosis (EEEA) (80.9%). Hypoplastic aortic arch (HAA) occurred in 34.6% and bicuspid aortic valve in 21.1%. The isolated type was present in 249 (73.0%). Significant postoperative complications occurred in 5.6%. Thirty‐day mortality was 1.4%. At a median follow‐up of 10.2 years (IQR, 6‐15 years; FU completeness, 91.2%), there were eight late deaths (2.6%), most in the complex type. Among 298 survivors, 284 (95.3%) were in NYHA class I; 10 (3.0%) were on antihypertensive treatment. Reinterventions on aortic arch occurred only in 4.5%, being HAA a significant risk factor for reoperation ( P = 0.00173). Freedom from mortality and reintervention on aorta at 21 years were 93.5% and 93.6%, respectively. Conclusions Surgical repair of CoAo by EEEA without CPBP is a safe and low‐risk procedure, concerning either early or late outcomes, despite the presence of HAA and neonatal age can influence recoarctation. Most patients are clinically well in the long‐term, and only a few require antihypertensive therapy.Keywords
This publication has 19 references indexed in Scilit:
- Aortic arch repair in children with PHACE syndromeThe Journal of Thoracic and Cardiovascular Surgery, 2016
- Outcomes after aortic arch reconstruction for infants: deep hypothermic circulatory arrest versus moderate hypothermia with selective antegrade cerebral perfusionEuropean Journal of Cardio-Thoracic Surgery, 2015
- Hypoplasia, Pseudocoarctation and Coarctation of the Aorta – A Systematic ReviewNew Zealand Medical Journal, 2015
- Fate of the Hypoplastic Proximal Aortic Arch in Infants Undergoing Repair for Coarctation of the Aorta Through a Left ThoracotomyThe Annals of Thoracic Surgery, 2014
- Coarctation of the AortaJournal of the American College of Cardiology, 2013
- Contemporary patterns of surgery and outcomes for aortic coarctation: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery DatabaseThe Journal of Thoracic and Cardiovascular Surgery, 2013
- ESC Guidelines for the management of grown-up congenital heart disease (new version 2010): The Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC)European Heart Journal, 2010
- Coarctation repair using end-to-side anastomosis of descending aorta to proximal aortic archThe Annals of Thoracic Surgery, 1996
- A Method of Enlarging the Distal Transverse Arch in Infants with Hypoplasia and Coarctation of the AortaThe Annals of Thoracic Surgery, 1977
- Surgical Correction of Coarctation of the Aorta by an "Isthmusplastic" OperationThorax, 1961