Surgical Strategy for Aortic Coarctation Repair Resulting in Physiologic Arm and Leg Blood Pressures

Abstract

For aortic coarctation repair in infancy, a strategy designed to directly address aortic arch hypoplasia results in excellent intermediate-term results with normal BP, physiologic arm:leg BP relationship, and near normal descending aortic blood flow velocities by Doppler.

Prenatal Prediction of Surgical Approach for Coarctation of the Aorta Repair

“…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. Specifically, recoarctation of the aorta, which usually implies the need for reintervention, has been reported in 2-25% of patients after native CoAo repair [7,31,35,36]. This wide interval may be attributed, at least partially, to the characteristics of the population, with the highest rates being observed in patients diagnosed in fetal life [31], and in those that need be repaired in the neonatal period [32,33,34].…”

“…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.…”

“…However, this approach exposes the patient to the risks of cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest. Left thoracotomy avoids CPB but implies poor exposure of the proximal aortic arch and very limited access to the heart, and therefore this approach is usually preferred when the hypoplastic segment is located after the origin of the left common carotid artery and is an isolated defect (simple CoAo) [3,4,5,6,7]. The complexity of cardiovascular defect and surgical technique explain that patients requiring median sternotomy have higher early postoperative morbidity [8], higher rate of recurrent laryngeal nerve lesion [8,9], worse neurodevelopmental outcome [10,11,12,13,14,15], and higher mortality (hazard ratio 11.6, 95% CI 2.3-57.9) [16] when compared with those who are repaired through a left thoracotomy [17,18].…”

Aortic Coarctation Repair in Neonates with Intracardiac Defects: The Importance of Preservation of the Lesser Curvature of the Aortic Arch

“…Hypertension and associated vasculopathies are the main concern of late outcome in patients with repaired CoA . Extended end‐to‐end repair through a sternotomy has been commonly used, especially when CoA is associated with hypoplasia of the aortic arch and/or an intracardiac anomaly requiring repair . The longer incision on the undersurface of the arch results in a wider anastomosis.…”

“…5,6 Extended end-to-end repair through a sternotomy has been commonly used, especially when CoA is associated with hypoplasia of the aortic arch and/or an intracardiac anomaly requiring repair. 7 The longer incision on the undersurface of the arch results in a wider anastomosis. Although the rate of recoarctation is very low, even this technique is unable to prevent a reduction of arterial compliance in the upper limbs.…”