Abstract
Objective. To describe the mid-term results of surgical repair of the aortic recoarctation.
Material and methods. We retrospectively reviewed our results of surgical repair of the aortic arch reobstruction using antegrade cerebral perfusion technique between 2008 and 2020.
Results. Fifty-one patients with the aortic recoarctation without concomitant CHD were included in this study. 62,7% of patients had the bicuspidal aortic valve, 10% had a vascular ring (the aberrant right subclavian artery). Surgical correction included prosthetic patch aortoplasty in 45%, resection with wide end-to-end anastomosis and a tube interposition graft in 29% and 25% respectively. Median interval between initial and redo surgery was 5 years, median age at reintervention was 9 years. No early and late deaths. Chylothorax occurred in 2 (3,9%) patients in the postop period.
Conclusion. Nowadays, endovascular techniques for the aortic recoarctation repair are alternative to surgical treatment. Long-term results analysis demonstrated a high risk of complications and recoarctation. Results of our study demonstrate that surgical repair can actually be performed with very high success, low morbidity and mortality rates.
References
- Carrico A., Moura C., Monterroso J., Casanova J., de Sousa R., Bastos P. et al. Patients with aortic coarctation operated during the first year of life, different surgical techniques and prognostic factors-21 years of experience. Rev. Port. Cardiol. 2003; 22: 1185–93.
- Brown J.W., Ruzmetov M., Hoyer M.H., Rodefeld M.D., Turrentine M.W. Recurrent coarctation: is surgical repair of recurrent coarctation of the aorta safe and effective? Ann. Thorac. Surg. 2009; 88: 1923–31. DOI: 10.1016/j.athoracsur.2009.07.024
- Campbell M. Natural history of coarctation of the aorta. Br. Geart. J. 1970; 32: 633–40. DOI: 10.1136/hrt.32.5.633
- Ralph-Edwards A.C., Williams W.G., Coles J.C., Rebeyka I.M., Trusler G.A., Freedom R.M. Reoperation for recurrent aortic coarctation. Ann. Thorac. Surg. 1995; 60: 1303–7. DOI: 10.1016/0003-4975(95)00619-V
- Walhout R.J., Lekkerkerker J.C., Oron G.H., Hitchcock F.J., Meijboom E.J., Bennink G.B.W.E. Comparison of polytetrafluoroethylene patch aortoplasty and end-to-end anastomosis for coarctation of the aorta. J. Thorac. Cardiovasc. Surg. 2003; 126: 521–8. DOI: 10.1016/s0022-5223(03)00030-8
- Corno A.F., Botta U., Hurni M., Payot M., Sekarski N., Tozzi P. et al. Surgery for aortic coarctation: a 30 years experience. Eur. J. Cardiothorac. Surg. 2001; 20: 1202–6. DOI: 10.1016/s1010-7940(01)00996-4
- Kim Y.Y., Andrade L., Cook S.C. Aortic coarctation. Cardiol. Clin. 2020; 38: 337–51. DOI: 10.1016/j.ccl.2020.04.003
- Mery C.M., Guzman-Pruned F.A., Trost J.G., McLaughlin E., Smith B.M., Parekh D.R. et al. Contemporary results of aortic coarctation repair through left thoracotomy. Ann. Thorac. Surg. 2015; 100: 1039–46. DOI: 10.1016/j.athoracsur. 2015.04.129
- Wood A.E., Javadpour H., Duff D., Oslizlok P., Walsh K. Is extended arch aortoplasty the operation of choice for infant aortic coarctation? Results of 15 years’ experience in 181 patients. Ann. Thorac. Surg. 2004; 77: 1353–7. DOI: 10.1016/j.athoracsur.2003.07.045
- Sudarshan C.D., Cochrane A.D., Jun Z.H., Soto R., Brizard C.P. Repair of coarctation of the aorta in infants weighing less than 2 kilograms. Ann. Thorac. Surg. 2006; 82: 158–63. DOI: 10.1016/j.athoracsur.2006.03.007
- Kappetein A.P., Zwinderman A.H., Bogers A.J., Rohmer J., Huysmans H.A. More than thirty-five years of coarctation repair. An unexpected high relapse rate. J. Thorac. Cardiovasc. Surg. 1994; 107: 87–95.
- Machii M., Becker A.E. Hypoplastic aortic arch morphology pertinent to growth after surgical correction of aortic coarctation. Ann. Thorac. Surg. 1997; 64: 516–20. DOI: 10.1016/S0003-4975(97)00444-X
- Lehnert A., Villemain O., Gaudin R., Meot M., Raisky O., Bonnet D. Risk factors of mortality and recoarctation after coarctation repair in infancy. Interact. Cardiovasc. Thorac. Surg. 2019; 29: 469–75. DOI: 10.1093/icvts/ivz117
- Burch P.T., Cowley C.G., Holubkov R., Null D., Lambert L.M., Kouretas P.C. et al. Coarctation repair in neonates and young infants: is small size or low weight still a risk factor? J. Thorac. Cardiovasc. Surg. 2009; 138: 547–52. DOI: 10.1016/j.jtcvs. 2009.04.046
- Kaushal S., Backer C.L., Patel J.N., Patel S.K., Walker B.L., Weigel T.J. et al. Coarctation of the aorta: midterm outcomes of resection with extended end-to-end anastomosis. Ann. Thorac. Surg. 2009; 88: 1932–8. DOI: 10.1016/j.athoracsur.2009.08.035
- Kotani Y., Anggriawan S., Chetan D., Zhao L., Liyanage N., Saedi A. et al. Fate of the hypoplastic proximal aortic arch in infants undergoing repair for coarctation of the aorta through a left thoracotomy. Ann. Thorac. Surg. 2014; 98: 1386–93. DOI: 10.1016/j.athoracsur.2014.05.042
- Sandoval N.F., Acevedo C.V., Umana J.B., Pineda I., Guerrero A., Obando C. et al. Wide dissection and intercostal vessel division allows for repair of hypoplastic aortic arch through thoracotomy. World J. Pediatr. Congenit. Heart Surg. 2018; 9: 659–64. DOI: 10.1177/2150135118799631
- Susheel Kumar T.K., Zurakowski D., Rishika Sharma, Saini S., Jonas R.A. Prediction of recurrent coarctation by early postoperative blood pressure gradient. J. Thorac. Cardiovasc. Surg. 2011; 142: 1130–6. DOI: 10.1016/j.jtcvs.2011.02.048
- Truong D.T., Tani L.Y., Minich L.L., Burch P.T., Bardsley T.R., Menon S.C. Factors associated with recoarctation after surgical repair of coarctation of the aorta by way of thoracotomy in young infants. Pediatr. Cardiol. 2014; 35: 164–70. DOI: 10.1007/s00246-013-0757-6
- Karamlou T., Bernasconi A., Jaeggi E., Alhabshan F., Williams W.G., Van Arsdell G.S. et al. Factors associated with arch reintervention and growth of the aortic arch after coarctation repair in neonates weighing less than 2.5 kg. J. Thorac. Cardiovasc. Surg. 2009; 137: 1163–7. DOI: 10.1016/j.jtcvs.2008.07.065
- Russell G.A., Berry P.J., Watterson K., Dhasmana J.P., Wisheart J.D. Patterns of ductal tissue in coarctation of the aorta in the first three months of life. J. Thorac. Cadriovasc. Surg. 1991; 102: 596–601.
- Harris K.C., Du W., Cowley C.G., Forbes T.J., Kim D.W. A prospective observational multicenter study of balloon angioplasty for the treatment of native and recurrent coarctation of the aorta. Catheter. Cardiovasc. Interv. 2014; 83: 1116–23. DOI: 10.1002/ccd.25284
- Fruh S., Knirsch W., Dodge-Khatami A., Dave H., Pretre R., Kretschmar O. Comparison of surgical and interventional therapy of native and recurrent aortic coarctation regarding different age groups during childhood. Eur. J. Cardiothorac. Surg. 2011; 39: 898–904. DOI: 10.1016/j.ejcts.2010. 09.048 24. Saxena A. Recurrent coarctation: interventional techniques and results. World J. Pediatr. Congenit. Heart Surg. 2015; 6: 257–65. DOI: 10.1177/2150135114566099
- Forbes T.J., Garekar S., Amin Z., Zahn E.M., Nykanen D., Moore P. et al. Congenital Cardiovascular Interventional Study Consortium (CCISC): procedural results and acute complications in stenting native and recurrent coarctation of the aorta in patients over 4 years of age: a multi-institutional study. Catheter. Cardiovasc. Interv. 2007; 70 (2): 276–85. DOI: 10.1002/ccd.21164
- Holzer R., Qureshi S., Ghasemi A., Vincent J., Sievert H., Gruenstein D. et al. Stenting of aortic coarctation: acute, intermediate, and long-term results of a prospective multi-institutional registry – Congenital Cardiovascular Interventional Study Consortium (CCISC). Catheter. Cardiovasc. Interv. 2010; 76 (4): 553–63. DOI: 10.1002/ccd.22587
- Thanopoulos B.D., Giannakoulas G., Giannopoulos A., Galdo F., Tsaoussis G.S. Initial and six-year results of stent implantation for aortic coarctation in children. Am. J. Cardiol. 2012; 109 (10): 1499–503. DOI: 10.1016/j.amjcard.2012. 01.365
- Forbes T.J., Moore P., Pedra C.A., Zahn E.M., Nykanen D., Amin Z. et al. Intermediate follow up following intravascular stenting for treatment of coarctation of the aorta. Catheter. Cardiovasc. Interv. 2007; 70 (4): 569–77. DOI: 10.1002/ccd.21191
- Anjos R., Qureshi S.A., Rosenthal E., Murdoch I., Hayes A., Parsons J. et al. Determinants of hemodynamic results of balloon dilation of aortic recoarctation. Am. J. Cardiol. 1992; 69: 665–71. DOI: 10.1016/0002-9149(92)90161-q
- Liu J.Y.J., Kowalski R., Jones B., Konstantinov I.E., Cheung M.M.H., Donath S. et al. Moderately hypoplastic arches: do they reliably grow into adulthood after conventional coarctation repair? Interact. Cardiovasc. Thorac. Surg. 2010; 10: 582–6. DOI: 10.1510/icvts.2009.223776
- Kron I.L., Flanagan T.L., Rheuban K.S., Carpenter M.A., Gutgesell Jr H.P., Blackbourne L.H. et al. Incidence and risk of reintervention after coarctation repair. Ann. Thorac. Surg. 1990; 49: 920–5. DOI: 10.1016/0003-4975(90)90867-6
About the authors
- Oleg A. Egunov, Cardiovascular Surgeon; ORCID
- Roman S. Kozhanov, Resident Physician; ORCID
- Valeriya M. Bayankina, Anesthesiologist-Intensivist; ORCID
- Aleksandr A. Sokolov, Dr. Med. Sci., Head of Laboratory of Ultrasound and Functional Research Methods;
ORCID
- Evgeniy V. Krivoshchekov, Dr. Med. Sci., Haed of Cardiac Surgery Department No. 2; ORCID
