Results of Coarctation Repair by Thoracotomy in Pediatric Patients: A Single Institution Experience

Heremans, L.; Henkens, Arnaud; Beco, Geoffroy de; Carbonez, Karlien; Moniotte, Stéphane; Rubay, Jean; Momeni, Mona; Houtekie, Laurent; Poncelet, Alain

doi:10.1177/21501351211003505

Cited by 3 publications

(4 citation statements)

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“…In this series, 14/343 patients (4.1%) required reintervention, a lower rate of reintervention than documented in most studies reporting on reintervention after repair of CoA via lateral thoracotomy. [21,22,24,25] In this series reported by Mery and colleagues, the reinterventions consisted mainly of catheter-based reintervention (n = 10). Moreover, Mery and colleagues reported that a postoperative peak velocity of ≥ 2.5 m/s was the only independent predictor for reintervention in multivariate analysis (odds ratio 4.0, 95% con dence interval 1.4-11.6, p = 0.01).…”

Section: Resultsmentioning

confidence: 93%

“…[18] Yet, in the modern era, early mortality following CoA repair is consistently low, below 5%. [10,12,[19][20][21][22][23][24][25][26] Most of these studies report a perioperative mortality rate of 1-3%, [10,12,19,[21][22][23][24] though one study reported zero Operative Mortality. [20] Gropler and colleagues [20] conducted a retrospective single institutional review of 251 patients undergoing extended end-to-end CoA repair with or without VSD repair.…”

Section: Resultsmentioning

confidence: 99%

“…Reintervention following CoA repair is a known complication that tends to be higher in patients undergoing lateral thoracotomy. [10,[21][22][23][24][25] Mery and colleagues published two large institutional studies highlighting longitudinal outcomes of a sternotomy-based approach to hypoplastic aortic arch repair, [12] and of a thoracotomy-based approach to CoA repair. [10] In the rst of these studies, Mery and colleagues [12] reported their experience with 275 infants undergoing coarctectomy and end-to-side anastomosis via median sternotomy from 1995-2012.…”

Section: Resultsmentioning

confidence: 99%

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15-Year Analysis of Surgical Approaches and Outcomes for Coarctation in 132 Neonates and Infants

Stukov,

Jacobs,

Sharaf

et al. 2024

Pediatr Cardiol

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Background: A variety of surgical approaches exist to treat aortic coarctation in neonates and infants.Our institutional approach is designed to match the surgical approach to the individual anatomy of the patient. The objective of this study is to evaluate operative characteristics and outcomes of all neonates and infants undergoing surgical repair of aortic coarctation or hypoplastic aortic arch.Methods: Retrospective review of 132 patients aged 0-1 year who underwent surgical repair of coarctation or hypoplastic aortic arch between 2006 and 2021, inclusive, either in isolation or with concomitant repair of atrial septal defect (ASD) and/or ventricular septal defect (VSD). Patients were divided into two groups based on the surgical approach: Group 1 = Median Sternotomy and Group 2 = Left Lateral Thoracotomy. Continuous variables are presented as median (minimum-maximum); categorical variables are presented as N (%).Results: The most common operative technique in Group 1 was end-to-side reconstruction with ligation of the aortic isthmus. The most common operative technique in Group 2 was extended end-to-end repair.Operative Mortality was one patient (1/132 = 0.76%). Transcatheter intervention for recurrent coarctation was performed in seven patients (7/132 = 5.3%). Surgical re-intervention for recurrent coarctation was performed in three patients (3/132 = 2.3%).Conclusions: A strategy of matching the surgical approach to the anatomy for neonates and infants undergoing surgical repair of coarctation or hypoplastic aortic arch, either in isolation or with concomitant repair of ASD and/or VSD, is associated with <1% Operative Mortality and <3% recurrent coarctation requiring reoperation.

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Section: Resultsmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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15-Year Analysis of Surgical Approaches and Outcomes for Coarctation in 132 Neonates and Infants

Stukov,

Jacobs,

Sharaf

et al. 2024

Pediatr Cardiol

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“…Different studies have reported the following factors affecting recoarctation: proximal arch hypoplasia, 12 suture type, 12,13 aberrant right subclavian artery, low weight, 14 and surgical technique. 15,16 Recently, Heremans et al 17 reported a recoarctation rate of 13.5%, while Farag et al 18 reported a rate of 9.9% and IJsselhof et al 19 reported a rate of 10.3% in the neonatal group and 4.6% in the infant group. In our study, eight (8.8%) patients developed recoarctation: four of these patients underwent balloon angioplasty and four underwent reoperation.…”

Section: Discussionmentioning

confidence: 99%

Isolated coarctation repair through a left thoracotomy in children

et al. 2022

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Introduction: Isolated aortic coarctation performed through a left thoracotomy resection and end-to-end anastomosis results in low mortality and morbidity rates. Recoarctation and late hypertension are among the most important complications after such repairs. In this study, we reviewed the results of children who underwent left-side thoracotomy to correct an isolated aortic coarctation. Method: A consecutive sample of 90 patients who underwent resection and extended end-to-end anastomosis through a left-side thoracotomy in our centre between 2011 and 2021 was retrospectively analysed. The patients' preoperative characteristics, operative data, and post-operative early and long-term results were examined Results: All patients underwent resection and extended end-to-end anastomosis. A pulmonary artery band was applied simultaneously to three (3.3%) patients, and an aberrant right subclavian artery division was applied to one (1.1%) patient. The mean cross-clamp time was 29.13 ± 6.97 minutes. Two (2.2%) patients required reoperation in the early period. Mortality was observed in one (1.1%) patient in the early period. Eight (8.8%) patients developed recoarctation, of whom four (4.4%) underwent reoperation and four (4.4%) underwent balloon angioplasty. Twenty-two (26.8%) patients received follow-up antihypertensive treatment. The mean follow-up period was 41.3 ± 22.8 months. No mortality was observed in the late period. Conclusion: Isolated coarctation is successfully treated with left-side thoracotomy resection and an extended end-to-end anastomosis technique with low mortality, morbidity, and low long-term recoarctation rates. Long-term follow-up is required due to the risks of early and late post-operative recoarctation, which requires reintervention.

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15-Year Analysis of Surgical Approaches and Outcomes for Coarctation in 132 Neonates and Infants

Jacobs,

Sharaf,

Peek

et al. 2023

Preprint

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Background: A variety of surgical approaches exist to treat aortic coarctation in neonates and infants. Our institutional approach is designed to match the surgical approach to the individual anatomy of the patient. The objective of this study is to evaluate operative characteristics and outcomes of all neonates and infants undergoing surgical repair of aortic coarctation or hypoplastic aortic arch. Methods: Retrospective review of 132 patients aged 0-1 year who underwent surgical repair of coarctation or hypoplastic aortic arch between 2006 and 2021, inclusive, either in isolation or with concomitant repair of atrial septal defect (ASD) and/or ventricular septal defect (VSD). Patients were divided into two groups based on the surgical approach: Group 1 = Median Sternotomy and Group 2 = Left Lateral Thoracotomy. Continuous variables are presented as median (minimum-maximum); categorical variables are presented as N (%). Results: The most common operative technique in Group 1 was end-to-side reconstruction with ligation of the aortic isthmus. The most common operative technique in Group 2 was extended end-to-end repair. Operative Mortality was one patient (1/132 = 0.76%). Transcatheter intervention for recurrent coarctation was performed in seven patients (7/132 = 5.3%). Surgical re-intervention for recurrent coarctation was performed in three patients (3/132 = 2.3%). Conclusions: A strategy of matching the surgical approach to the anatomy for neonates and infants undergoing surgical repair of coarctation or hypoplastic aortic arch, either in isolation or with concomitant repair of ASD and/or VSD, is associated with <1% Operative Mortality and <3% recurrent coarctation requiring reoperation.

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Results of Coarctation Repair by Thoracotomy in Pediatric Patients: A Single Institution Experience

Cited by 3 publications

References 25 publications

15-Year Analysis of Surgical Approaches and Outcomes for Coarctation in 132 Neonates and Infants

15-Year Analysis of Surgical Approaches and Outcomes for Coarctation in 132 Neonates and Infants

Isolated coarctation repair through a left thoracotomy in children

15-Year Analysis of Surgical Approaches and Outcomes for Coarctation in 132 Neonates and Infants

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