Repair of isolated aortic coarctation over two decades: impact of surgical approach and associated arch hypoplasia

Abstract

OBJECTIVES: A variety of surgical approaches and techniques are used for isolated coarctation repair. We have retrospectively reviewed our results of isolated repair of coarctation over the last 20 years, to establish whether the approach affects clinical outcome and the need for re-intervention. METHODS:Two hundred and eighty-eight patients who underwent isolated repair for coarctation of the aorta at Birmingham Children's Hospital between 1991 and 2010 were enrolled in this study. Chart review and the Departmental database were used to determine demographics, operative details and complications. RESULTS:The majority of patients (n = 237, 82%) underwent surgical repair via thoracotomy techniques, whereas median sternotomy was used in patients where there was associated arch hypoplasia (n = 51, 18%). For all 288 patients, median age at operation was 24 days (range 0-14 years). Between 1991 and 2000, ten patients (6%) underwent repair through midline sternotomy, increasing to 41 patients (36%) between 2001 and 2010. Overall early mortality was 1% and late mortality was 3%. There was a statistically higher reintervention rate (16%) in the decade 1991-2000, compared to 5% in the period 2001-10 (P = 0.02). In patients with hypoplastic arch, the midline approach has a lower re-intervention rate than thoracotomy (P < 0.001). CONCLUSIONS:In our institution, there has been a trend in recent years towards increased use of median sternotomy to repair the aortic arch, which has been associated with a reduced rate of re-intervention. The midline sternotomy approach for coarctation with arch hypoplasia significantly reduces the risk of re-coarctation.

Hipertensión arterial resistente y coartación de aorta

“…Por el contrario, aunque la cirugía de la coartación de aorta aislada conlleva excelentes resultados a corto y largo plazo, sigue existiendo una necesidad significativa de reintervención en estos pacientes 10 .…”

Prenatal Prediction of Surgical Approach for Coarctation of the Aorta Repair

“…Several surgical techniques are available, and they all associated with low rates of mortality and severe morbidity [7,28,29,30]. Nevertheless, the rate of complications differ widely depending on factors such as the time of diagnosis, the age at repair, or the severity of aortic narrowing, and it has been shown that fetal diagnosis [31], the need to repair in the neonatal period [32,33,34], and long segment aortic arch hypoplasia [6,32,33] adversely affect the outcome.…”

Selective cerebral and coronary perfusion in the correction of coarctation of the aorta with tubular aortic arch hypoplasia (literature review)

“…Гипоплазированной считается дуга, размер которой в миллиметрах меньше, чем вес ребенка в килограммах плюс один [7]. Также можно найти упоминание следующего критерия гипоплазии: диаметр аорты менее диаметра брахиоцефального ствола [8].…”