Mid-Term Outcomes of Repair of Coarctation of Aorta With Hypoplastic Arch: Extended End-to-side Anastomosis Technique

Abstract

The optimal surgical repair technique for coarctation associated with aortic arch hypoplasia (CoA-AAH) in neonates and infants is controversial. This study evaluates our current strategy using extended end-to-side anastomosis under selective cerebral and myocardial perfusion in treating this group of patients. Through a retrospective review, we analyzed the outcome of 87 infants who underwent surgical repair of CoA-AAH from January 2004 to December 2015. Patients with functional single ventricle were excluded. There were no early mortalities, and 4 patients (4.6%) experienced early complications. Eighty-five patients (97.7%) were followed up during a mean duration of 6.1 ± 3.53 years. There were 2 late mortalities (2.3%) and 3 reintervention (3.5%) of the aortic arch. Ten-year overall survival and freedom from reintervention for the entire cohort was 97.7% and 96.3%, respectively. At last follow-up, 4 patients (4.5%) showed a peak velocity greater than 2.5 m/s across the repair site. Seven patients (8.2%) were hypertensive. Our strategy with extended end-to-side anastomosis under selective cerebral and myocardial perfusion is safe and effective for repairing CoA-AAH in neonates and infants. Concomitant repair of associated cardiac anomalies can be done without added risk. Mid-term results are excellent with low rates of mortality, reintervention, and late hypertension.