Short-Term Outcomes of Two Surgical Techniques for the Treatment of Coarctation of the Aorta in Infants: Subclavian Flap Repair and Resection with Extended End-to-End Anastomosis Technique
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Author(s)
Mustafa Karaçelik1, Burçin Abud2*, Uğur Karagöz1, Pelin Ozturk1, Gökhan Albayrak3, Onur Doyurgan1, Koray Aykut3, Mehmet Güzeloğlu3, Eyüp Hazan3, Osman Nejat Sarıosmanoğlu1
Affiliation(s)
1Department of Pediatric Cardiac Surgery, Behcet Uz Children’s Hospital, Izmir, Turkey.
2Department of Cardiovascular Surgery, Izmir Tepecik Research and Training Hospital, Izmir, Turkey.
3Department of Cardiovascular Surgery, Izmir University School of Medicine, Izmir, Turkey.
2Department of Cardiovascular Surgery, Izmir Tepecik Research and Training Hospital, Izmir, Turkey.
3Department of Cardiovascular Surgery, Izmir University School of Medicine, Izmir, Turkey.
ABSTRACT
Background:
The aims of the study were to analyze the importance of two different
surgical procedures, and to determine outcomes for neonates with
coarctation of the aorta in two newly established centers. Methods:
Outcomes of two different surgical repairs for coarctation of the aorta
in 43 infants were evaluated retrospectively. The study was designed as a
nonrandomized, cross-sectional study. The subclavian flap repair was
applied to 22 patients (51%) and resection with extended end-to-end
anastomosis technique to 21 patients (49%). After all operative
survivors were followed up with a mean follow-up of 1.8 ± 0.8 years,
data analyzed with t-test and the p value < 0.05 were considered
statistically significant. Results: The overall mortality rate was 4.6%.
Forty mmHg gradients were determined in a patient from Resection Group
postoperatively in the fifteenth month. After the balloon angioplasty,
the gradient decreased to 25 mmHg. The presence of ventricular septal
defect (p = 0.094) was the only significant predictor of adverse
short-term outcome among the associated cardiac defects analyzed. The
first-year survival rate was 100% in both groups in isolated coarctation
(p = 0.965), however; such rate was found as 100% and 93.25% in
Waldhausen Group and Resection Group, respectively in complex
coarctation (p = 0.294). Conclusions: Both the subclavian flap repair
and resection with extended end-to-end anastomosis for coarctation of
the aorta in infants provide excellent short-term outcomes with lower
recurrence rates requiring surgery or angioplasty.
Cite this paper
References
Karaçelik,
M. , Abud, B. , Karagöz, U. , Ozturk, P. , Albayrak, G. , Doyurgan, O. ,
Aykut, K. , Güzeloğlu, M. , Hazan, E. and Sarıosmanoğlu, O. (2015)
Short-Term Outcomes of Two Surgical Techniques for the Treatment of
Coarctation of the Aorta in Infants: Subclavian Flap Repair and
Resection with Extended End-to-End Anastomosis Technique. World Journal of Cardiovascular Diseases, 5, 1-8. doi: 10.4236/wjcd.2015.51001.
[1] | Uguz, E., Ozkan, S., Akay, H.T., Gültekin, B. and Aslamaci, S. (2010) Surgical Repair of Coarctation of Aorta in Neonates And Infants: A 10 Years Experience. Turkish Journal of Thoracic and Cardiovascular Surgery, 18, 94-99. |
[2] | Gargiulo, G., Napoleone, C.P., Angeli, E. and Oppido, G. (2008) Neonatal Coarctation Repair Using Extended End-to- End Anastomosis. Multimedia Manual of Cardiothoracic Surgery: MMCTS/European Association for Cardio-Thoracic Surgery, 1, 328. |
[3] | Cobanoglu,
A., Thyagarajan, G.K. and Dobbs, J.L. (1998) Surgery for Coarctation of
the Aorta in Infants Younger than 3 Months: End-to-end Repair versus
Subclavian Flap Angioplasty: Is Either Operation Better? European
Journal Cardio-Thoracic Surgery, 14, 19-26. http://dx.doi.org/10.1016/S1010-7940(98)00142-0 |
[4] | Pfammatter,
J.P., Ziemer, G., Kaulitz, R., et al. (1996) Isolated Aortic
Coarctation in Neonates and Infants: Results of Resection and End-to-End
Anastomosis. The Annals of Thoracic Surgery, 62, 778-783. http://dx.doi.org/10.1016/S0003-4975(96)00502-5 |
[5] | Adams,
E.E., Davidson Jr., W.R., Swallow, N.A., et al. (2013) Long-Term
Results of the Subclavian Flap Repair for Coarctation of the Aorta in
Infants. World Journal for Pediatric and Congenital Heart Surgery, 4,
13-18. http://dx.doi.org/10.1177/2150135112466878 |
[6] | Wright,
G.E., Nowak, C.A., Goldberg, C.S., et al. (2005) Extended resection and
end-to-end anastomosis for aortic coarctation in infants: results of a
tailored surgical approach. The Annals of Thoracic Surgery, 80,
1453-1459. http://dx.doi.org/10.1016/j.athoracsur.2005.04.002 |
[7] | Kaushal,
S., Backer, C.L., Patel, J.N., et al. (2009) Coarctation of the Aorta:
Midterm Outcomes of Resection with Extended End-to-End Anastomosis. The
Annals of Thoracic Surgery, 88, 1932-1938. http://dx.doi.org/10.1016/j.athoracsur.2009.08.035 |
[8] | Conte,
S., Lacour-Gayet, F., Serraf, A., et al. (1995) Surgical Management of
Neonatal Coarctation. The Journal of Tho- racic and Cardiovascular
Surgery, 109, 663-675. http://dx.doi.org/10.1016/S0022-5223(95)70347-0 |
[9] | Uchytil, B., Aern, J., Niaovsk, J., et al. (2003) Surgery for Coarctation of the Aorta: Long-Term Post-Operative Results. Scripta Medica (BRNO), 76, 347-356. |
[10] | Pandey,
R., Jackson, M., Ajab, S., Gladman, G. and Pozzi, M. (2006) Subclavian
Flap Repair: Review of 399 Patients at Median Follow-Up of Fourteen
Years. The Annals of Thoracic Surgery, 81, 1420-1428. http://dx.doi.org/10.1016/j.athoracsur.2005.08.070 |
[11] | Ungerleider,
R.M., Pasquali, S.K., Welke, K.F., et al. (2013) Contemporary Patterns
of Surgery and Outcomes for Aortic Coarctation: An Analysis of the
Society of Thoracic Surgeons Congenital Heart Surgery Database. The
Journal of Thoracic and Cardiovascular Surgery, 145, 1-20. http://dx.doi.org/10.1016/j.jtcvs.2012.09.053 |
[12] | Puchalski,
M.D., Williams, R.V., Hawkins, J.A., Minich, L.L. and Tani, L.Y. (2004)
Follow-Up of Aortic Coarctation Repair in Neonates. Journal of the
American College of Cardiology, 44, 188-191. http://dx.doi.org/10.1016/j.jacc.2004.01.052 |
[13] | Quaegebeur, J.M., Jonas, R.A., Weinberg, A.D., Blackstone, E.H. and Kirklin, J.W. (1994) The Results in Seriously Ill Neonates with Coarctation of the Aorta: A Multi-Institutional Study. The Journal of Thoracic and Cardiovascular Surgery, 108, 841-854. |
[14] | Backer, C.L., Paape, K., Zales, V.R., Weigel, T.J. and Mavroudis, C. (1995) Coarctation of the Aorta: Repair with Polytetrafluoroethylene Patch Aortoplasty. Circulation, 92, 132-136. |
[15] | Crawford, F.A.J. and Sade, R.M. (1984) Spinal Cord Injury Associated with Hyperthermia during Aortic Coarctation Repair. The Journal of Thoracic and Cardiovascular Surgery, 87, 616-618. |
[16] | Setty,
S.P., Brizard, C.P. and d’Udekem, Y. (2007) Partial Cardiopulmonary
Bypass in Infants with Coarctation and Anomalous Right Subclavian
Arteries. The Annals of Thoracic Surgery, 84, 715. http://dx.doi.org/10.1016/j.athoracsur.2006.12.065 |
[17] | Zehr,
K.J., Gillinov, A.M., Redmonb, J.M., et al. (1995) Repair of
Coarctation of the Aorta in Neonates and Infants: A Thirty-Year
Experience. The Annals of Thoracic Surgery, 59, 33-41. http://dx.doi.org/10.1016/0003-4975(94)00825-R |
[18] | Barreiro,
C.J., Ellison, T.A., Williams, J.A., et al. (2007) Subclavian Flap
Aortoplasty: Still a Safe, Reproducible and Effective Treatment for
Infant Coarctation. European Journal Cardio-Thoracic Surgery, 31,
649-653. http://dx.doi.org/10.1016/j.ejcts.2006.12.038 |
[19] | Dodge-Khatami,
A., Backer, C.L. and Mavroudis, C. (2000) Risk Factors for
Recoarctation and Results of Reoperation: A 40-Year Review. Journal of
Cardiac Surgery, 15, 369-377. http://dx.doi.org/10.1111/j.1540-8191.2000.tb01295.x |
[20] | Dehaki, M.G., Ghavidel, A.A., Givtaj, N., Omrani, G. and Salehi, S. (2010) Recurrence Rate of Different Techniques for Repair of Coarctation of the Aorta: A 10 Years Experience. Annals of Pediatric Cardiology, 3, 123-126. eww150113lx |
[21] | Kirklin, J.W. and Barrat-Boyes, B.G. (2012) Cardiac Surgery. 4th Edition, Elsevier Saunders, Philadelphia. |
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