Surgical treatment of aortic coarctation in infants younger than three months

1985 to 1990: Success of extended end-to-end arch aortoplasty

L. W.E. Van Heurn, C. M. Wong, D. J. Spiegelhalter, K. Sorensen, M. R. De Leval, J. Stark, M. J. Elliott, J. J. Amato, John Myers, J. G. Coles

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Abstract

There remains controversy regarding the appropriate surgical treatment of coarctation of the aorta in infants. In 1985 we introduced the extended end- to-end repair into our practice and now wish to present a review of our recent experience. One hundred fifty-one infants younger than 3 months of age underwent repair of coarctation between 1985 and 1990. In 25% and 33% of the patients, there was hypoplasia of the isthmus and of the transverse arch, respectively. Surgical procedures were as follows: subclavian flap angioplasty in 15 patients, resection with a traditional end-to-end anastomosis in 43, and resection with an extended end-to-end anastomosis into the arch in 77. In 30 patients, the extension was proximal to the origin of the left carotid artery (radically extended end-to-end anastomosis). Other procedures were used in 16 patients. Mortality (13 early and 12 late deaths) was related on multivariate analysis to the presence of an associated major heart defect, preoperative resuscitation, and direct postoperative gradient over the arch. This immediate postoperative gradient was significantly lower after both extended and radically extended end-to-end anastomosis if there was a hypoplastic isthmus, and after radically extended end-to-end anastomosis if the transverse arch was hypoplastic. Actuarial freedom from recoarctation at 4 years was 57% (confidence limits 28% to 78%) after subclavian flap angioplasty, 77% (confidence limits 60% to 87%) after end- to-end anastomosis, 83% (confidence limits 66% to 92%) after extended end- to-end anastomosis and 96% (confidence limits 77% to 100%) after radically extended end-to-end anastomosis. We conclude that the extended end-to-end anastomosis and radical end-to-end anastomosis appear to offer the best prognosis for all infants with coarctation. The technique can be applied successfully to almost all types of arch anomalies.

Original languageEnglish (US)
Pages (from-to)74-86
Number of pages13
JournalJournal of Thoracic and Cardiovascular Surgery
Volume107
Issue number1
StatePublished - Jan 1 1994

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Aortic Coarctation
Angioplasty
Therapeutics
Carotid Arteries
Resuscitation
Multivariate Analysis
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Van Heurn, L. W. E., Wong, C. M., Spiegelhalter, D. J., Sorensen, K., De Leval, M. R., Stark, J., ... Coles, J. G. (1994). Surgical treatment of aortic coarctation in infants younger than three months: 1985 to 1990: Success of extended end-to-end arch aortoplasty. Journal of Thoracic and Cardiovascular Surgery, 107(1), 74-86.
Van Heurn, L. W.E. ; Wong, C. M. ; Spiegelhalter, D. J. ; Sorensen, K. ; De Leval, M. R. ; Stark, J. ; Elliott, M. J. ; Amato, J. J. ; Myers, John ; Coles, J. G. / Surgical treatment of aortic coarctation in infants younger than three months : 1985 to 1990: Success of extended end-to-end arch aortoplasty. In: Journal of Thoracic and Cardiovascular Surgery. 1994 ; Vol. 107, No. 1. pp. 74-86.
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abstract = "There remains controversy regarding the appropriate surgical treatment of coarctation of the aorta in infants. In 1985 we introduced the extended end- to-end repair into our practice and now wish to present a review of our recent experience. One hundred fifty-one infants younger than 3 months of age underwent repair of coarctation between 1985 and 1990. In 25{\%} and 33{\%} of the patients, there was hypoplasia of the isthmus and of the transverse arch, respectively. Surgical procedures were as follows: subclavian flap angioplasty in 15 patients, resection with a traditional end-to-end anastomosis in 43, and resection with an extended end-to-end anastomosis into the arch in 77. In 30 patients, the extension was proximal to the origin of the left carotid artery (radically extended end-to-end anastomosis). Other procedures were used in 16 patients. Mortality (13 early and 12 late deaths) was related on multivariate analysis to the presence of an associated major heart defect, preoperative resuscitation, and direct postoperative gradient over the arch. This immediate postoperative gradient was significantly lower after both extended and radically extended end-to-end anastomosis if there was a hypoplastic isthmus, and after radically extended end-to-end anastomosis if the transverse arch was hypoplastic. Actuarial freedom from recoarctation at 4 years was 57{\%} (confidence limits 28{\%} to 78{\%}) after subclavian flap angioplasty, 77{\%} (confidence limits 60{\%} to 87{\%}) after end- to-end anastomosis, 83{\%} (confidence limits 66{\%} to 92{\%}) after extended end- to-end anastomosis and 96{\%} (confidence limits 77{\%} to 100{\%}) after radically extended end-to-end anastomosis. We conclude that the extended end-to-end anastomosis and radical end-to-end anastomosis appear to offer the best prognosis for all infants with coarctation. The technique can be applied successfully to almost all types of arch anomalies.",
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Van Heurn, LWE, Wong, CM, Spiegelhalter, DJ, Sorensen, K, De Leval, MR, Stark, J, Elliott, MJ, Amato, JJ, Myers, J & Coles, JG 1994, 'Surgical treatment of aortic coarctation in infants younger than three months: 1985 to 1990: Success of extended end-to-end arch aortoplasty', Journal of Thoracic and Cardiovascular Surgery, vol. 107, no. 1, pp. 74-86.

Surgical treatment of aortic coarctation in infants younger than three months : 1985 to 1990: Success of extended end-to-end arch aortoplasty. / Van Heurn, L. W.E.; Wong, C. M.; Spiegelhalter, D. J.; Sorensen, K.; De Leval, M. R.; Stark, J.; Elliott, M. J.; Amato, J. J.; Myers, John; Coles, J. G.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 107, No. 1, 01.01.1994, p. 74-86.

Research output: Contribution to journalArticle

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T1 - Surgical treatment of aortic coarctation in infants younger than three months

T2 - 1985 to 1990: Success of extended end-to-end arch aortoplasty

AU - Van Heurn, L. W.E.

AU - Wong, C. M.

AU - Spiegelhalter, D. J.

AU - Sorensen, K.

AU - De Leval, M. R.

AU - Stark, J.

AU - Elliott, M. J.

AU - Amato, J. J.

AU - Myers, John

AU - Coles, J. G.

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N2 - There remains controversy regarding the appropriate surgical treatment of coarctation of the aorta in infants. In 1985 we introduced the extended end- to-end repair into our practice and now wish to present a review of our recent experience. One hundred fifty-one infants younger than 3 months of age underwent repair of coarctation between 1985 and 1990. In 25% and 33% of the patients, there was hypoplasia of the isthmus and of the transverse arch, respectively. Surgical procedures were as follows: subclavian flap angioplasty in 15 patients, resection with a traditional end-to-end anastomosis in 43, and resection with an extended end-to-end anastomosis into the arch in 77. In 30 patients, the extension was proximal to the origin of the left carotid artery (radically extended end-to-end anastomosis). Other procedures were used in 16 patients. Mortality (13 early and 12 late deaths) was related on multivariate analysis to the presence of an associated major heart defect, preoperative resuscitation, and direct postoperative gradient over the arch. This immediate postoperative gradient was significantly lower after both extended and radically extended end-to-end anastomosis if there was a hypoplastic isthmus, and after radically extended end-to-end anastomosis if the transverse arch was hypoplastic. Actuarial freedom from recoarctation at 4 years was 57% (confidence limits 28% to 78%) after subclavian flap angioplasty, 77% (confidence limits 60% to 87%) after end- to-end anastomosis, 83% (confidence limits 66% to 92%) after extended end- to-end anastomosis and 96% (confidence limits 77% to 100%) after radically extended end-to-end anastomosis. We conclude that the extended end-to-end anastomosis and radical end-to-end anastomosis appear to offer the best prognosis for all infants with coarctation. The technique can be applied successfully to almost all types of arch anomalies.

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