Abstract
To evaluate early and long-term results of surgical treatment of aortic coarctation (CoAo) in neonates. This is a retrospective clinical review of neonates with CoAo, who underwent surgery between 1995 and 2019. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by means of relative risk ratio and Cox and logistic multivariate analysis. 218 consecutive neonates (M/F: 129/89, median age 11 days, IQR 7–17 days) were included; 202 (92.7%) had a left thoracotomy; 178 underwent extended end-to-end anastomosis (EEEA, 81.6%). Hypoplastic aortic arch (HAA) was present in 102 patients (46.8%); complex cardiac anomalies in 85 (39%). Significant postoperative complications occurred in 20 (9.2%). Thirty-day mortality was 2.3% (most in complex types). At a median follow-up of 10.4 years (IQR 5.6–15.0 years; FU completeness 95.9%), there were 8 late deaths (3.7%), all associated to complex CoAo. Among 196 survivors, 177 (93.2%) were in NYHA class I; re-interventions on aortic arch occurred in 9.2% (2.0% were surgical). Freedom from mortality and re-intervention on aorta at 10 years were 94.3% and 96.7%, respectively. Surgical repair of CoAo in newborns without CPB in our series was safe and low-risk, with excellent early and late outcomes.
Highlights
Aortic coarctation (CoAo) is a common congenital heart disease (CHD), occurring in approximately 4 out of 10,000 live births [1, 2], which may be isolated or complex, when associated with other CHDs, such as a bicuspid aortic valveThis paper was presented at the CHSS&ECHSA Joint Meeting, Boston October 24th and 25th, 2020.(BAV), ventricular septal defect (VSD), and hypoplastic aortic arch (HAA) [3]
The presence of HAA can be determinant for choosing the surgical approach or use of cardio-pulmonary bypass (CPB), deep hypothermic circulatory arrest (DHCA) [7], or selective antegrade cerebral perfusion (ACP) [5, 8]
relative risk (RR) for late onset of Hypertension Sex Age class at surgery (≤ 15 gg) Bicuspid aortic valve Hypoplastic LV Pre-CoAo procedure HAA Isolated vs complex Single ventricle Type of surgical procedure extended end-to-end anastomosis (EEEA) Other Sternotomy and cardio-pulmonary bypass Thoracotomy Associated surgical procedures Urgent procedure
Summary
Aortic coarctation (CoAo) is a common congenital heart disease (CHD), occurring in approximately 4 out of 10,000 live births [1, 2], which may be isolated or complex, when associated with other CHDs, such as a bicuspid aortic valve. The presence of HAA can be determinant for choosing the surgical approach (i.e., sternotomy vs thoracotomy) or use of cardio-pulmonary bypass (CPB), deep hypothermic circulatory arrest (DHCA) [7], or selective antegrade cerebral perfusion (ACP) [5, 8]. The optimal surgical approach for CoAo repair in neonates, especially when associated with HAA, is controversial. Numerous studies have explored postoperative outcomes [8, 14,15,16] They had a relatively short follow-up, were limited to one surgical approach, or included patients undergoing surgical repair at different ages. We reviewed our experience with neonatal repair of CoAo, to assess early and late morbidity, mortality, and re-intervention rate, with particular attention to late clinical outcomes
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