Surgical Treatment Following Stent Angioplasty for High-Risk Neonates With Critical Coarctation of the Aorta

Abstract

Background Neonatal coarctation of the aorta (CoA) is primarily treated by surgical repair. However, under certain high-risk constellations, initial stent angioplasty may be considered followed by surgical repair. We report our experience with this staged approach. Methods: All patients undergoing surgical CoA repair following prior stenting at our institution between January 2011 and December 2019 were included in this retrospective analysis. The patients were classified to be at high risk because of cardiogenic shock, associated complex cardiac malformations, neonatal infection, necrotizing enterocolitis, and extracardiac conditions, respectively. Outcomes were analyzed and compared with neonates who underwent surgical CoA repair without prior stenting in the same observation period. Results Twenty-six neonates received stent implantation at a median age of 20 days (IQR 9-33 days). Subsequent surgical repair was conducted at an age of 4.2 months (IQR 3.2-6.1 months) with a median body weight of 5.6 kg (IQR 4.5-6.5 kg). Cardiopulmonary bypass was applied in 96% of cases. Extended end-to-end anastomosis was possible in 11 patients. Extended reconstruction with patch material was necessary in the remaining patients. One fatality (3.8%) occurred 33 days postoperatively. At a median follow-up of 5.2 years after initial stenting, all remaining patients were alive; 15/25 patients (60%) were free from re-intervention. Of note, re-intervention rates were comparable in neonates (n = 76) who were operated on with native CoA (28/74 patients; 38%; P = .67). Conclusions Neonatal stent angioplasty for CoA results in increased complexity of the subsequent surgical repair. Nevertheless, this staged approach allows to bridge high-risk neonates to later surgical repair with reduced perioperative risk and acceptable midterm outcomes.

Multiple Perfusion Strategies for Complex Aortic Arch Reconstruction: Same Result

“…We have read with interest the letter to the Editor titled "Perfusion During Aortic Arch Surgery-Keep it Physiologic!" by Grieshaber et al 1 related to our case presentation of "Aortic uncrossing of circumflex aorta." 2 The authors' have discussed their perfusion strategy for pediatric/neonatal arch surgeries.…”

“…We have read with interest the letter to the Editor titled “Perfusion During Aortic Arch Surgery–Keep it Physiologic!” by Grieshaber et al 1 related to our case presentation of “Aortic uncrossing of circumflex aorta.” 2 The authors’ have discussed their perfusion strategy for pediatric/neonatal arch surgeries. This combined perfusion approach of selective antegrade cerebral perfusion (SACP) and descending aortic perfusion via femoral artery has been used by different surgical teams with good outcomes offering considerable mesenteric and renal protection.…”