Isolated Coarctation Repair in Neonates and Infants Through Left Thoracotomy: Short-Term Outcomes

Abstract

Introduction: End-to-end anastomosis and extended end-to-end anastomosis are typically used as surgical approaches to coarctation of the aorta (CoAo) with access at the subclavian artery or an interposition graft. The objective of this study is to analyze the impact of surgical and anatomical characteristics and techniques on early outcomes after surgical treatment of CoAo without cardiopulmonary bypass through left thoracotomy. Methods: This is a quantitative, observational, and cross-sectional analysis of patients who underwent repair of CoAo between July 1, 2010 and December 31, 2017. Seventy-two patients were divided into three groups according to age: 34 in group A (≤ 30 days), 24 in group B (31 days to one year), and 14 in group C (≥ 1 year to 18 years). Results: Aortic arch hypoplasia was associated in 30.8% of the cases, followed by ventricular septal defect (13.2%). The preductal location was more frequent in group A (73.5%), ductal in group B (41.7%), and postductal in group C (71.4%). Long coarcted segment was predominant in groups A and C (61.8% and 71.4%, respectively) and localized in group B (58.3%). Extended end-to-end anastomosis technique was prevalent (68%), mainly in group A (91.2%). Mortality in 30 days was 1.4%. Conclusion: Most of the patients were children under one year of age, and extended end-to-end anastomosis was the most used technique, secondary to arch hypoplasia. Further, overall mortality was low in spite of moderate morbidity in the first 30 postoperative days.

Isolated coarctation repair through a left thoracotomy in children

“…One recent study presenting the results of isolated coarctation with thoracotomy reported a mortality rate of 1.4%. 26 In our study, mortality was observed in one (1.1%) patient, who underwent surgery under extracorporeal membrane oxygenation in the preoperative period, left-side extracorporeal membrane oxygenation in the post-operative period, and died of sepsis 30 days after surgery. The exclusion of patients with complex disease and severe transverse arch hypoplasia is one reason for the low mortality rate observed in the present study.…”