The aortal arch plasty in a new-born babies, using “end-to-side” anastomosis
Objective. To analyze the immediate and late follow-up results of the aortal arch plasty, using anastomosis «end to side».
Materials and methods. In 2010 - 2019 yrs period in Amosov National Institute of Cardio-Vascular Surgery and Scientific-Practical Medical Centre of Pediatric Cardiology and Cardiosurgery in 75 new-born babies, suffering coarctation and hypoplasia of one or several segments of aortal arch its reconstruction was done, using ‘end-to-side” anastomosis. Into the investigation only the patients with a two-ventricular physiology and further two-ventricular correction were included. There were 41 (54.6%) boys and 34 (45.4%) girls. Average age of the patients was (2,5 ± 1,2) mo, and average body mass - (3.3 ± 0.6) kg. The main diagnostic method for the failure determination and immediate and late results studying was echocardiographic investigation.
Results. Hospital lethality have constituted 6.6% (5 patients died). The lethality causes were not connected with the aortal arch reconstructive procedure, using anastomosis «end to side». Duration of follow-up was 1 mo - 9.3 yrs, (2.8 ± 2.5) yrs at average. In late follow-up period 1 patient died. In 11 (14.6%) patients in postoperative period the aortal arch restenosis have developed. In 7 patients restenosis was eliminated endovascularly, using balloon dilatation. In 4 patients the aortal arch surgical replasty was done. Tracheal and the main bronchi compression, neurological complications in late follow-up period were not observed.
Conclusion. After plasty for the aortal arch hypoplasia, using anastomosis «end to side» in new-born babies good immediate and late follow-up results were noted, what witnesses its efficacy. In accordance to results of the investigation accomplished such kind of anastomosis applied may be used in patients, suffering hypoplasia of proximal aorta or in tubular hypoplasia of all aortal arch.
Herbst C, Laufer G, Greil S, Kitzmueller E, Base E, Vargha R, et al. Autologous aortic arch reconstruction in isolated and combined cardiac lesions. Eur Surg; 52(3): 165-70. doi: 10.1007/s10353-019-00611-5.
Kaushal S, Backer CL, Patel JN, Patel SK, Walker BL, Weigel TJ, et al. Coarctation of the aorta: midterm outcomes of resection with extended end-to-end anastomosis. Ann Thorac Surg. 2009 Dec;88(6):1932-8. doi: 10.1016/j.athoracsur.2009.08.035. PMID: 19932265.
Lee MG, Brink J, Galati JC, Rakhra SS, Konstantinov IE, Cheung MM, et al. End-to-side repair for aortic arch lesions offers excellent chances to reach adulthood without reoperation. Ann Thorac Surg. 2014 Oct;98(4):1405-11. doi: 10.1016/j.athoracsur.2014.05.007. Epub 2014 Jul 17. PMID: 25042678.
Ramachandran P, Khoury PR, Beekman RH, Michelfelder EC, Manning PB, Tweddell JS, et al. Preoperative Aortic Arch Size and Late Outcome After Coarctation Repair by Lateral Thoracotomy. Ann Thorac Surg. 2018 Aug;106(2):575-80. doi: 10.1016/j.athoracsur.2018.03.084. Epub 2018 May 5. PMID: 29733824.
Dharmapuram AK, Ramadoss N, Verma S, Vejendla G, Ivatury RM. Early outcomes of modification of end to side repair of coarctation of aorta with arch hypoplasia in neonates and infants. Ann Pediatr Cardiol. 2018 Sep-Dec;11(3):267-74. doi: 10.4103/apc.APC_5_18. PMID: 30271016; PMCID: PMC6146848.
Liu JY, Jones B, Cheung MM, Galati JC, Koleff J, Konstantinov IE, et al. Favourable anatomy after end-to-side repair of interrupted aortic arch. Heart Lung Circ. 2014 Mar;23(3):256-64. doi: 10.1016/j.hlc.2013.08.006. Epub 2013 Aug 30. PMID: 24060690.
Yamashiro M, Takahashi Y, Ando M, Kikuchi T. End-to-side anastomosis for coarctation of the aorta and type A aortic arch interruption with hypoplastic aortic arch. Jpn J Thorac Cardiovasc Surg. 2006 Jul;54(7):273-7. doi: 10.1007/pl00022252. PMID: 16898639.
Lee MG, Kowalski R, Galati JC, Cheung MM, Jones B, Koleff J, et al. Twenty-four-hour ambulatory blood pressure monitoring detects a high prevalence of hypertension late after coarctation repair in patients with hypoplastic arches. J Thorac Cardiovasc Surg. 2012 Nov;144(5):1110-6. doi: 10.1016/j.jtcvs.2012.08.013. Epub 2012 Sep 11. PMID: 22980064.
This work is licensed under a Creative Commons Attribution 4.0 International License.