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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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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
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.
 
References
[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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