Outcome after extended arch repair for aortic coarctation

Abstract

Objectives: To assess survival and long term arch patency rates in a consecutive group of children after extended arch repair for coarctation of the aorta. Methods: Review of 191 consecutive children (154 (81%) under 1 year of age) operated on between 1990 and 2002 by a single surgeon using extended arch reconstructive techniques. For assessment of survival patients were divided into three groups: 1, coarctation alone, n = 104; 2, coarctation and ventricular septal defect, n = 38; and 3, coarctation in association with complex intracardiac anomalies, n = 49. A prospective and systematic clinical and echocardiographic evaluation of the aortic arch was undertaken. Results: Median time to follow up was 4.2 years (range 1-10.6 years). Overall actuarial survival was 92%, 88%, and 88% at two, five, and 10 years. Mortality was significantly higher in those patients with complex intracardiac anatomy. Arch obstruction recurred in seven of 165 (4.2%) patients: four of 139 (2.9%) term and three of 10 (30%) premature infants (p , 0.001). Conclusions: Survival after extended arch reconstruction for coarctation is excellent. At long follow up recurrent arch obstruction is rare, with prematurity the only risk factor.

Mortality and Restenosis Rate of Surgical Coarctation Repair in Infancy: A Study of 191 Patients

“…Both factors can be summarized to a very small aortic arch, not only confined to the coarctation site. Several recent studies [5,6,7, 19] reported less restenosis rates of 4–14%, but the median follow-ups of about 4 years in each study were substantially shorter than that of our study. Additionally, a closer look at our Kaplan-Meier curve outlines that there was a substantial occurrence of restenosis also late after surgery.…”

“…However, comparative stent implantation data are still missing. In this discussion, surgical data are often cited that are outdated, are drawn from small or selected patient groups [5], or are drawn from patients with additional cardiac malformations [6,7,8]. These studies included approximately one third of patients with isolated coarctation, another third of patients with coarctation and ventricular septal defect and a third of patients with concomitant complex heart defects.…”

Coarctation of the Aorta - The Current State of Surgical and Transcatheter Therapies

“…The most recent data suggests low mortality, shorter cross-clamp times, and lower recoarctation rates at 4-13% looking at patients 5-10 years post-surgery [46-52]. The procedure has low mortality even on patients under two kilograms [53] and has been thought to maintain long-term aortic compliance [54].…”

Coarctation repair—redo challenges in the adults: what to do?

“…After ligation and division of the ductus arteriosus, the coarctation segment is resected and the aortic arch is opened on its inferior aspect, followed by end-to-end anastomosis of the opened arch and the descending aorta. The procedure can be performed with low peri-operative mortality and reports show relatively low re-coarctation rates of 4% to 13% (19,(35)(36)(37)(38)(39)(40).…”