Repair of coarctation of the aorta with a subclavian flap

Waldhausen, John A.; Nahrwold, David L.

doi:10.1016/s0022-5223(19)43319-9

Cited by 301 publications

(51 citation statements)

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“…All these patients were subjected to resection of the coarctation and an end-to-end anastomosis according to Crafoord (Crafoord & Nylin , 1945). With the introduction of the so-called 'Subflavian flap technique' (Waldhausen & Nahrwold, 1966;Hamilton et al, 1981;Mellgren et al, 1987), where the left subclavian artery is included in the aortic wall, there is reason to expect fewer problems with decreased distensibility and propagation of the arterial pulse through the anastomosis area in the future. However, it may be concluded from this study, with some reservations, that patients with fairly normal femoral artery pulse tracings generally have rather wide anastomoses and that patients with markedly pathological pulse curves often have narrow ones.…”

Section: Discussionmentioning

confidence: 99%

Non‐invasive evaluation of the long‐term results of coarctectomy in childhood

Wallentin

Hanson

Eriksson

1988

Clinical Physiology

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Nineteen young men operated upon for coarctation of the aorta in childhood were studied with pulse tracings from the femoral and carotid arteries and echocardiographic examination of the heart with estimation of the degree of hypertrophy and valve anomalies. The results were compared with intra-arterial blood-pressure measurements and angiographically measured width of the aortic anastomosis. Patients with markedly distorted pulse curves had the narrowest anastomoses although no uniform pattern could be detected. Although one of the selection criteria was 'no other known cardiovascular malformations', only three of the patients had completely normal aortic and mitral valves. Nine of the patients had left ventricular hypertrophy but the degree of hypertrophy could not be correlated to the degree of arterial hypertension. The importance of long-term follow-up of these patients, who in spite of surgery have a remaining cardiovascular excess mortality, is emphasized. Pulse tracings and echocardiography seem to be of value for this purpose.

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Section: Discussionmentioning

confidence: 99%

Non‐invasive evaluation of the long‐term results of coarctectomy in childhood

Wallentin

Hanson

Eriksson

1988

Clinical Physiology

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“…have been proposed over the years, such as isthmusplasty, 5 subclavian flap aortoplasty, 6 extended end-to-end anastomosis (EEEA), 7 end to side anastomosis (ESA), 8 and patch or conduit repair. 9 Besides, association to hypoplastic aortic arch (HAA) may influence the surgical approach (ie, sternotomy vs thoracotomy) or utilization of cardiopulmonary bypass (CPBP) and deep hypothermic cardiac arrest (DHCA).…”

Section: Different Surgical Techniquesmentioning

confidence: 99%

“…Surgical technique for CoAo repair has been reported elsewhere. [4][5][6][7] Briefly, we performed CoAo repair mostly by lateral thoracotomy: on right lateral decubitus, a thoracotomy in the fourth intercostal space is made. After lung retraction, we expose the aortic isthmus and CoAo.…”

Section: Surgical Techniquementioning

confidence: 99%

Surgical repair of aortic coarctation in pediatric age: A single center two decades experience

et al. 2019

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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.

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“…27,28 Given concern about the lack of growth of circumferential anastomoses, Waldhausen in 1966 repaired coarctation with the left subclavian patch aortoplasty procedure, which eliminated the circumferential anastomosis, but still left the patient with abnormal ductal tissue. 29 Current surgical repairs include the use of extended end to end anastomosis, aortic arch advancement, and rarely, patch aortoplasty. 30 The risk of complication from isolated coarctation repair is low, with a mortality rate less than 1%.…”

Section: Secundum Asdmentioning

confidence: 99%

Long-term Follow-up of “Simple” Lesions-Atrial Septal Defect, Ventricular Septal Defect, and Coarctation of the Aorta

Goldberg

2015

Congenit Heart Dis

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Surgery for congenital heart disease has advanced significantly in the past 50 years, such that repair of "simple" lesions, such as atrial septal defect, ventricular septal defect, and coarctation of the aorta carries minimal risk, with mortality risk much less than 1%. It was once thought successful repair of these lesions was definitively corrective. There is mounting evidence, however, that there are long-term complications after these repairs, prompting the need for continued follow-up. This review describes the current understanding of diagnosis, treatment, and long-term outcomes for these patients, with the goal of advocating for lifelong surveillance. As the perioperative care of these repairs has evolved significantly over time, so must the way in which we study these patients in the long-term.

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Repair of coarctation of the aorta with a subclavian flap

Cited by 301 publications

References 0 publications

Non‐invasive evaluation of the long‐term results of coarctectomy in childhood

Non‐invasive evaluation of the long‐term results of coarctectomy in childhood

Surgical repair of aortic coarctation in pediatric age: A single center two decades experience

Long-term Follow-up of “Simple” Lesions-Atrial Septal Defect, Ventricular Septal Defect, and Coarctation of the Aorta

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