Surgery for aortic re-coarctation in children less than 10 years old. A single center experience in Siberia, Russia

Abstract

Background: Persistence or recurrence of stenosis is a complication of initial coarctation repair. This study aims to report short-term outcomes of surgical management of recurrent coarctation and initial repair analysis. Methods: We retrospectively reviewed our experience with 51 patients undergoing recoarctation surgical repair between 2008 and 2019 using antegrade cerebral perfusion technique. Results: Surgical correction included prosthetic patch aortoplasty in 23 (45%), resection with wide end-to-end anastomosis in 15 (29%) and a tube interposition graft in 13 (25%) patients. Median age at initial correction and reintervention were 12 month and 9 years. Median interval from primary repair to reintervention was 60 months. Initial repair analysis revealed 33% of patients had initial correction in the neonatal period, 72,5% of patients were done via a left thoracotomy approach and 63% of patients had end-to-end anastomosis at initial surgery. Conclusion: Our study demonstrates that surgical repair of recurrent coarctation of the aorta using antegrade cerebral perfusion technique can be performed safely and with excellent results.

Coarctation of the aorta with aortic arch hypoplasia: Tackle from the front or the side?

“…The authors in this series have used a PTFE patch, which has a lesser susceptibility for contraction and reactive residual ductal tissue is not a factor in reoperations. Recurrence of coarctation is a time‐dependent outcome as shown in this study and other studies, and hence a follow‐up beyond the current median of 2 years is required to evaluate the continued success of this series 1,2 …”

“…Recurrence of coarctation is a time-dependent outcome as shown in this study and other studies, and hence a follow-up beyond the current median of 2 years is required to evaluate the continued success of this series. 1,2 In conclusion, coarctation resection via a thoracotomy approach should still be considered especially when there is less than moderate transverse arch hypoplasia. In cases where there is a lack of expectant growth, a reoperation from the front can be performed with excellent outcomes, as shown in this study.…”

“…The risk factor could have been an inadequate resection of ductal tissue, use of patch material that is susceptible to shrinkage, and the inability of the repaired segments to catch up with tremendous somatic growth. Arch augmentation from the front is thus not entirely recurrence risk‐free 1,3 . The authors in this series have used a PTFE patch, which has a lesser susceptibility for contraction and reactive residual ductal tissue is not a factor in reoperations.…”

“…Arch augmentation from the front is thus not entirely recurrence risk-free. 1,3 The authors in this series have used a PTFE patch, which has a lesser susceptibility for contraction and reactive residual ductal tissue is not a factor in reoperations.…”

“…In their single‐institution retrospective review, Egunov et al describe the short‐term outcomes of the pediatric patients who underwent reoperative surgery for residual or recurrent coarctation after a previous coarctation repair 1 . There were 51 patients over 12 years.…”