Late results of surgical treatment of the aortal arch hypoplasia in newborns and babies
Objective. To conduct the analysis of late results of the aortal arch reconstruction in newborns and babies, basing on determination of the risk factors for lethality and reoperations.
Materials and methods. In 2010 - 2019 yrs in the Amosov National Institute of Cardiovascular Surgery and Scientific-Practical Medical Centre of Pediatric Cardiology and Cardiosurgery the aortal arch reconstruction was performed in 445 patients, ageing up to 1 year old, suffering coarctation and hypoplasia of one or several aortal segments. Into the investigation were included the patients with a two-ventricular physiology and further two-ventricular correction were included. There were 161 (36.2%) girls and 284 (63.8%) boys with the age median 0.7 mo [0.3; 2.7], while the body mass median – 3.7 kg [3.25; 4.59], and the body surface square median – 0.23 m2 [0.20;0.27]. Echocardiography was the main diagnostic method for the failure as well as for estimation of immediate and late results.
Results. Overall lethality have constituted 3.3%, the hospital one – 2.7%, lethality in late period of observation – 0.7%. The observation period have lasted from 1 mo till 9.4 yrs, (2.8 ±2.5) yrs at average. Reoperations on aortal arch were performed in 47 (10.5%) patients: in 12 – surgical aortal arch rereconstruction, in 27 – balloon angioplasty, and in 8 patients both methods were used. The risk factors for lethality after the aortal arch reconstruction in the patients, ageing up to 1 yr old were revealed: the patients’ age on the operation moment lesser than 0.9 mo, the body mass lesser than 2.6 kg, durable operation, presence of concurrent inborn heart failures, residual hypoplasia of the aortal segments A and B. Low mass and the surface square of the body, presence of the aortal arch segments hypoplasia preoperatively, residual pressure gradient on the aortal arch more than 20 mm Hg, hypoplasia of any aortal arch segments after reconstruction have constituted the risk factors for reoperations.
Conclusion. Surgical treatment of the aortal arch hypoplasia in newborns and babies is effective and giving good immediate and late results. Anatomic correction of secondary obstruction on the aortal arch level is secure, with low indices of lethality and reoperations, and performed either surgically or endoscopically. Taking into account the risk factors revealed for lethality and reoperations on aortal arch, have permitted to improve the results of treatment of the aortal arch hypoplasia in patients ageing up to 1 yr old.
Onalan MA, Temur B, Aydın S, Basgoze S, Guzelmeric F, Odemis E, et al. Management of aortic arch hypoplasia in neonates and infants. J Card Surg. 2021 Jan;36(1):124-33. doi: 10.1111/jocs.15212. Epub 2020 Nov 22. PMID: 33225505.
Elgamal MA, McKenzie ED, Fraser CD Jr. Aortic arch advancement: the optimal one-stage approach for surgical management of neonatal coarctation with arch hypoplasia. Ann Thorac Surg. 2002 Apr;73(4):1267-72; discussion 1272-3. doi: 10.1016/s0003-4975(01)03622-0. PMID: 11998817.
Dodge-Khatami A, Backer CL, Mavroudis C. Risk factors for recoarctation and results of reoperation: a 40-year review. J Card Surg. 2000 Nov-Dec;15(6):369-77. doi: 10.1111/j.1540-8191.2000.tb01295.x. PMID: 11678458.
Brown JW, Ruzmetov M, Hoyer MH, Rodefeld MD, Turrentine MW. Recurrent coarctation: is surgical repair of recurrent coarctation of the aorta safe and effective? Ann Thorac Surg. 2009 Dec;88(6):1923-30; discussion 1930-1. doi: 10.1016/j.athoracsur.2009.07.024. PMID: 19932264.
Zoghbi J, Serraf A, Mohammadi S, Belli E, Lacour Gayet F, Aupecle B, et al. Is surgical intervention still indicated in recurrent aortic arch obstruction? J Thorac Cardiovasc Surg. 2004 Jan;127(1):203-12. doi: 10.1016/s0022-5223(03)01290-x. PMID: 14752432.
Sakurai T, Rogers V, Stickley J, Khan N, Jones TJ, Barron DJ, et al. Single-center experience of arch reconstruction in the setting of Norwood operation. Ann Thorac Surg. 2012 Nov;94(5):1534-9. doi: 10.1016/j.athoracsur.2012.05.097. Epub 2012 Jul 26. PMID: 22841016.
Kobayashi M, Ando M, Wada N, Takahashi Y. Outcomes following surgical repair of aortic arch obstructions with associated cardiac anomalies. Eur J Cardiothorac Surg. 2009 Apr;35(4):565-8. doi: 10.1016/j.ejcts.2008.09.052. Epub 2009 Jan 15. PMID: 19150241.
Mery CM, Guzmán-Pruneda FA, Trost JG Jr, McLaughlin E, Smith BM, Parekh DR, et al. Contemporary Results of Aortic Coarctation Repair Through Left Thoracotomy. Ann Thorac Surg. 2015 Sep;100(3):1039-46. doi: 10.1016/j.athoracsur.2015.04.129. Epub 2015 Jul 21. PMID: 26209490.
Thomson JD, Mulpur A, Guerrero R, Nagy Z, Gibbs JL, Watterson KG. Outcome after extended arch repair for aortic coarctation. Heart. 2006 Jan;92(1):90-4. doi: 10.1136/hrt.2004.058685. Epub 2005 Apr 21. PMID: 15845612; PMCID: PMC1860999.
Dias MQ, Barros A, Leite-Moreira A, Miranda JO. Risk Factors for Recoarctation and Mortality in Infants Submitted to Aortic Coarctation Repair: A Systematic Review. Pediatr Cardiol. 2020 Mar;41(3):561-75. doi: 10.1007/s00246-020-02319-w. Epub 2020 Feb 27. PMID: 32107586.
Devlin PJ, McCrindle BW, Kirklin JK, Blackstone EH, DeCampli WM, Caldarone CA, et al. Intervention for arch obstruction after the Norwood procedure: Prevalence, associated factors, and practice variability. J Thorac Cardiovasc Surg. 2019 Feb;157(2):684-95.e8. doi: 10.1016/j.jtcvs.2018.09.130. Epub 2018 Nov 22. PMID: 30669228.
Kim ER, Kim WH, Nam J, Choi K, Jang WS, Kwak JG. Mid-Term Outcomes of Repair of Coarctation of Aorta With Hypoplastic Arch: Extended End-to-side Anastomosis Technique. Semin Thorac Cardiovasc Surg. 2017 Oct 27:S1043-0679(17)30289-7. doi: 10.1053/j.semtcvs.2017.10.002. Epub ahead of print. PMID: 29111297.
Alkashkari W, Albugami S, Althobaiti M, Alfouti M, Alrahimi J, Kinsara A, et al. Transcatheter Intervention for Late Complications after Aortic Coarctation Surgical Repair. J Clin Trials. 2020;10(2): 402. doi: 10.35248/2167-0818.104.22.1682.
Brown JW, Ruzmetov M, Okada Y, Vijay P, Rodefeld MD, Turrentine MW. Outcomes in patients with interrupted aortic arch and associated anomalies: a 20-year experience. Eur J Cardiothorac Surg. 2006 May;29(5):666-73; discussion 673-4. doi: 10.1016/j.ejcts.2006.01.060. Epub 2006 Apr 12. PMID: 16626964.
Brown ML, Burkhart HM, Connolly HM, Dearani JA, Cetta F, Li Z, et al. Coarctation of the aorta: lifelong surveillance is mandatory following surgical repair. J Am Coll Cardiol. 2013 Sep 10;62(11):1020-5. doi: 10.1016/j.jacc.2013.06.016. Epub 2013 Jul 10. PMID: 23850909.
Ghani MOA, Raees MA, Harris GR, Shannon CN, Nicholson GT, Bichell DP. Reintervention After Infant Aortic Arch Repair Using a Tailored Autologous Pericardial Patch. Ann Thorac Surg. 2021 Mar;111(3):973-79. doi: 10.1016/j.athoracsur.2020.04.091. Epub 2020 Jun 6. PMID: 32512001.
This work is licensed under a Creative Commons Attribution 4.0 International License.