Complications following reparative surgery for aortic coarctation or interrupted aortic arch

Abstract

Repair of aortic coarctation or interrupted aortic arch continues to be associated with major long-term morbidity. Thus, we conducted a review of 87 consecutive patients who underwent aortic arch repairs, focusing particular attention on the complications that developed. A two-stage strategy was employed if cardiac lesions were associated. The median age at surgery was 1.5 months with a range of 12 h to 56 years. The aortic arch was repaired using end-to-end anastomosis, subclavian flap aortoplasty, subclavian arterial turning-down aortoplasty, patch aortoplasty, tube graft interposition, or other methods. There were 10 patients who died soon after repair, and all of whom had complex cardiac anomalies. Of the remaining 77 patients, 8 developed recurrent stenosis. These 8 patients were all similar in age, being under 3 months old, and weighing 4 kg or less. A multivariable analysis of the infants identified interrupted aortic arch as an independent risk factor for the development of this complication with an odds ratio of 6.45. Complications following prosthesis-free techniques were similar in prevalence and timing. All reinterventions were mortality-free, but catheter dilation and patch aortoplasty were not always successful. Three extraanatomic bypasses were successfully performed, and one adult who had undergone a previous graft and pseudoaneurysm operation was successfully treated with an extraanatomic bypass. These findings led us to conclude that the initial repair should be performed without a prosthesis, and that reintervention for stenosis should combine catheter dilation and extraanatomic bypass.

Surgical treatment for graft stenosis after repair of an interrupted aortic arch: Report of two cases

“…Aeba and associates reported that the indications for reoperation include a pressure gradient of at least 20 mmHg, a narrowing anastomotic site greater than or equal to 50% of the neighboring aortic diameter, or exercise-induced arm hypertension with a systolic pressure of at least 200 mmHg. 9 The surgical correction of graft stenosis can be achieved by various techniques. [10][11][12][13][14][15] One serious problem at reoperation involves ensuring effective cerebral protection in infants or children during reconstruction of the aortic arch, and another involves deciding whether to dissect around the previously inserted graft where severe adhesions may have developed.…”