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Margarint IM, Youssef T, Robu M, Rotaru I, Popescu A, Untaru O, Filip C, Stiru O, Iliescu VA, Vladareanu R. The Management of Aortic Coarctation Associated with Hypoplastic Arches and Particular Arch Anatomies: A Literature Review. J Pers Med 2024; 14:732. [PMID: 39063986 PMCID: PMC11277657 DOI: 10.3390/jpm14070732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
The surgical management of aortic coarctation in newborns needs to ensure postoperative evolution and long-term results as much as possible. Patients with a Gothic arch have a higher rate of postoperative hypertension, while newborns with a bovine arch have higher rates of restenosis and, thus, an additional risk of mortality. Late hypertension, even in anatomically successfully repaired patients, confers a high risk for cardiovascular events. This review of the literature focuses on the management of aortic coarctations associated with hypoplastic arch and particular arch anatomies, focusing on surgical techniques and their outcomes.
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Affiliation(s)
- Irina-Maria Margarint
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Tammam Youssef
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Mircea Robu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Iulian Rotaru
- Department of Cardiac Surgery, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania; (I.R.); (A.P.); (O.U.)
| | - Alexandru Popescu
- Department of Cardiac Surgery, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania; (I.R.); (A.P.); (O.U.)
| | - Olguta Untaru
- Department of Cardiac Surgery, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania; (I.R.); (A.P.); (O.U.)
| | - Cristina Filip
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Ovidiu Stiru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
| | - Radu Vladareanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (I.-M.M.); (C.F.); (O.S.); (V.A.I.); (R.V.)
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Kreuzer M, Sames-Dolzer E, Klapper M, Tulzer A, Mair R, Seeber F, Gierlinger G, Saric D, Mair R. The anatomic repair of recurrent aortic arch obstruction in children and adolescents. JTCVS OPEN 2024; 19:215-222. [PMID: 39015463 PMCID: PMC11247212 DOI: 10.1016/j.xjon.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/22/2024] [Accepted: 04/09/2024] [Indexed: 07/18/2024]
Abstract
Objective Surgery for recurrent aortic arch obstruction is highly challenging and publications are rare. The aim of this retrospective, single-center study was to evaluate mortality, complications, and reintervention rate after an anatomic repair. Methods Between 1999 and 2022, in total 946 operations on the aortic arch were performed at the Children's Heart Center Linz. In 39 cases, the indication was a recurrent or residual aortic arch obstruction or coarctation in a patient aged 18 years or younger. This is our study cohort. The aorta was reconstructed by a direct anastomosis/autograft in 20 patients, patch in 17 patients, and interposition graft in 2 adolescents. In 32 procedures, cardiopulmonary bypass with whole body perfusion was employed, in 4, antegrade cerebral perfusion was employed, in 2, a left heart bypass was employed, and in 1 no cardiopulmonary bypass was used. Results Median (Q1, Q3) age at operation was 253 days (100, 2198 days), weight 7.5 kg (4.5, 17.8 kg). Median cardiopulmonary bypass time was 177 minutes (115, 219 minutes), crossclamp time 73 minutes (49, 102 minutes). Three infants died during the hospital stay: 1 with Williams syndrome, 1 with hypoplastic left heart syndrome, and 1 with heterotaxia. There was no death due to an arch complication. The main complications were 1 neurologic injury after postoperative resuscitation (Williams syndrome) and 1 permanent recurrent laryngeal nerve paralysis. During the follow-up period of median 8.1 years (2.6, 12 years) 1 re-reintervention on the aortic arch was necessary. Conclusions Sophisticated reoperations on the aortic arch could be performed safely. In children, the growth potential of all segments of the aorta could be sustainably preserved by avoiding interposition or extra-anatomic bypass grafts.
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Affiliation(s)
- Michaela Kreuzer
- Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Eva Sames-Dolzer
- Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Melanie Klapper
- Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
| | - Andreas Tulzer
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Department of Pediatric Cardiology, Kepler University Hospital, Linz, Austria
| | - Roland Mair
- Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
| | - Fabian Seeber
- Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
| | - Gregor Gierlinger
- Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Dalibor Saric
- Department of Pediatric Cardiology, Klinički Bolnički Centar Zagreb, Zagreb, Croatia
| | - Rudolf Mair
- Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
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Winder MM, Ware A, Husain A, Griffiths E, Swink JM, Ou Z, Eckhauser A. Interdigitating Technique for Repair of Aortic Arch Obstruction to Reduce Reintervention Rates. Ann Thorac Surg 2024; 117:387-394. [PMID: 37414382 PMCID: PMC10764635 DOI: 10.1016/j.athoracsur.2023.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The incidence of reintervention for aortic arch obstruction is 5% to 14% after coarctation or hypoplastic aortic arch repair and 25% after the Norwood procedure. Institutional practice review indicated higher than reported reintervention rates. Our aim was to assess the impact of an interdigitating reconstruction technique on reintervention rates for recurrent aortic arch obstruction. METHODS Children (<18 years) were included if they had undergone aortic arch reconstruction by sternotomy or the Norwood procedure. Three surgeons participated in the intervention with staggered rollout dates between June 2017 and January 2019, with the study ending December 2020 and review for reinterventions ending February 2022. Preintervention cohorts represented patients who underwent aortic arch reconstructions with patch augmentation, and postintervention cohorts represented patients who underwent an interdigitating reconstruction technique. Reinterventions by cardiac catheterization or operation were measured within 1 year of initial operation. Wilcoxon rank sum and χ2 tests were used to compare preintervention and postintervention cohorts. RESULTS Overall, 237 patients were included for participation in this study, with 84 patients in the preintervention cohort and 153 in the postintervention cohort. Patients undergoing the Norwood procedure represented 30% (n = 25) of the retrospective cohort and 35% (n = 53) of the intervention cohort. Overall reinterventions were significantly decreased after the study intervention from 31% (n = 26/84) to 13% (n = 20/153; P < .001). Reintervention rates were decreased for each intervention cohort: aortic arch hypoplasia (24% [n = 14/59] vs 10% [n = 10/100]; P = .019) and Norwood procedure (48% [n = 12/25] vs 19% [n = 10/53]; P = .008). CONCLUSIONS The interdigitating reconstruction technique for obstructive aortic arch lesions was successfully implemented and is associated with a decrease in reinterventions.
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Affiliation(s)
- Melissa M Winder
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah; Heart Center, Primary Children's Hospital, Salt Lake City, Utah.
| | - Adam Ware
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Adil Husain
- Section of Pediatric Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Eric Griffiths
- Section of Pediatric Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | | | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Aaron Eckhauser
- Section of Pediatric Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
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Truba IP, Golovenko OS, Dziuryi IV. Restenosis Rate and Reinterventions after Aortic Arch Repair in Infants. UKRAINIAN JOURNAL OF CARDIOVASCULAR SURGERY 2022. [DOI: 10.30702/ujcvs/22.30(04)/tg056-5965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim. This study aims to determine the reintervention rate in infantsundergoing aortic arch repair and to analyze risk factors and evaluate the results of reinterventions.
Materials and methods. This retrospective study examines 445 infants with aortic arch hypoplasia who under-went aortic arch reconstruction between 2011 and 2019. The study included only patients with two-ventricle physiology and subsequent two-ventricle repair. Techniques for primary repair included extended end-to-end anastomosis (n = 348), end-to-side anastomosis (n = 611), autologous pericardial patch repair (n = 16).
Results. The overall mortality in the entire study group was 3.3 %. Follow-up period ranged from 1 month to 9.4 years (mean 2.8 ± 2.5 years). Restenosis at the site of aortic arch repair was identiϐied in 47 (10.5 %) patients. Of these, 12 patients underwent surgical reconstruction of the aortic arch, 27 patients underwent balloon angioplasty, and in 8 patients both methods were used. Freedom from reintervention was 89.4 % at 1-year follow-up and 87.5 % at 4-year follow-up. The most determining factorsfor restenosis were related to hypoplastic proximal aortic arch and body weight less than 2.5 kg.
Conclusions. Surgical treatment of aortic arch hypoplasia in newborns and infants is effective and shows good immediate and long-term results. Anatomical correction of reobstruction at the level of the aortic arch is safe with both endovacular and surgical methods with low mortality and incidence of repeated interventions. Identified risk factors for mortality and recurrent aortic arch interventions help to improve the treatment of aortic arch hypoplasia in patients under 1 year of age.
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Kurtz JD, Rubio AE, Johnston TA, Morray BH, Jones TK. Late Outcomes of Transcatheter Coarctation Intervention in Infants with Biventricular Anatomy. Pediatr Cardiol 2022; 43:1438-1443. [PMID: 35274168 DOI: 10.1007/s00246-022-02865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
Determine outcomes of catheter intervention for aortic coarctation in infants. Aortic coarctation in infants following surgical repair and in high surgical risk native cases remains a challenging problem. Catheter intervention is an alternative to surgical intervention. Single-center, chart review of infants with biventricular anatomy who underwent coarctation stent placement or balloon angioplasty between 04/2004 and 04/2020. Outcomes of interest included change in aortic lumen diameter, peak gradient, number of re-interventions, time to re-intervention, and adverse events. Thirty-four patients were included in analysis, of those 16 underwent stent placement. Patients' mean age was 4.0 ± 3.0 months and weight of 5.3 ± 1.9 kg. Follow-up interval was 5.4 ± 5.1 years (0.2-16.1 years). Twelve (35%) patients underwent procedure due to ventricular dysfunction; the rest were for high resting gradient. Coarctation diameter increased from 2.4 ± 1.0 to 4.5 ± 1.3 (p < 0.01) and gradient decreased from 32.0 ± 18.4 mmHg to 9.2 ± 8.8 mmHg (p < 0.01). Thirteen (81%) of the stented patients required at least one re-intervention, at an average of 1.7 ± 3.2 years from the index procedure. Five (28%) of those undergoing balloon angioplasty required repeat intervention. There was no mortality due to the procedure and one late mortality. One patient had a serious procedural adverse event. On follow-up, 12 (35%) were on anti-hypertensive medications. Catheter intervention, including stent placement, for aortic coarctation in infants is feasible with an acceptable adverse event profile. Repeat interventions are common.
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Affiliation(s)
- Joshua D Kurtz
- Division of Pediatric Cardiology, Department of Pediatrics, University of Washington/Seattle Children's Hospital, RC 2.820, PO Box 5371, Seattle, WA, 98105, US.
- Division of Pediatric Cardiology, Departments of Pediatrics, University of Louisville, 571 S. Floyd St., Ste 113, Louisville, KY, 40202, US.
| | - Agustin E Rubio
- Division of Pediatric Cardiology, Department of Pediatrics, University of Washington/Seattle Children's Hospital, RC 2.820, PO Box 5371, Seattle, WA, 98105, US
| | - Troy A Johnston
- Division of Pediatric Cardiology, Department of Pediatrics, University of Washington/Seattle Children's Hospital, RC 2.820, PO Box 5371, Seattle, WA, 98105, US
| | - Brian H Morray
- Division of Pediatric Cardiology, Department of Pediatrics, University of Washington/Seattle Children's Hospital, RC 2.820, PO Box 5371, Seattle, WA, 98105, US
| | - Thomas K Jones
- Division of Pediatric Cardiology, Department of Pediatrics, University of Washington/Seattle Children's Hospital, RC 2.820, PO Box 5371, Seattle, WA, 98105, US
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Nucera M, Glöckler M, Widenka H, Friess JO, Siepe M, Kadner A. Hybrid Approach for Correction of Recurrent Aortic Arch Obstruction After Repair of Interrupted Aortic Arch-A Case Report. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100088. [PMID: 37288062 PMCID: PMC10242564 DOI: 10.1016/j.shj.2022.100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/09/2023]
Affiliation(s)
- Maria Nucera
- Department of Cardiac Surgery, Center for Congenital Heart Disease, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Glöckler
- Department of Cardiology, Center for Congenital Heart Disease, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hannah Widenka
- Department of Cardiac Surgery, Center for Congenital Heart Disease, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan-Oliver Friess
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Siepe
- Department of Cardiac Surgery, Center for Congenital Heart Disease, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Kadner
- Department of Cardiac Surgery, Center for Congenital Heart Disease, Bern University Hospital, University of Bern, Bern, Switzerland
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Asai H, Cao Y, Ikarashi J, Arai Y, Ebuoka N, Tachibana T. Re-Norwood operation using femoral artery cannulation. Asian Cardiovasc Thorac Ann 2021; 30:726-728. [PMID: 34747227 DOI: 10.1177/02184923211047092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Re-Norwood operation is technically difficult to perform and is a high risk procedure due to the underlying hypocardiac function. Herein, we describe our successful re-Norwood operation approach in a 6-month old infant with persistent severe cyanosis and aortic re-coarctation. Our procedure was performed using femoral artery cannulation to protect cerebrospinal and lower body perfusion. Safe reopening of the chest was achieved, despite strong adhesions due to prior surgeries. Our repair and anastomosis techniques are described in detail. Cardiac circulation and function improved post-surgery. The patient was maintained on anti-heart failure drug therapy after surgery while awaiting a Glenn procedure.
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Affiliation(s)
- Hidetsugu Asai
- Department of Cardiovascular Surgery, 13701Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yuchen Cao
- Department of Cardiovascular Surgery, 13701Kanagawa Children's Medical Center, Yokohama, Japan
| | - Jin Ikarashi
- Department of Cardiovascular Surgery, 13701Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yosuke Arai
- Department of Cardiovascular and Thoracic Surgery, 88282Hokkaido Medical Center For Child Health and Rehabilitation, Sapporo, Japan
| | - Noriyoshi Ebuoka
- Department of Cardiovascular and Thoracic Surgery, 88282Hokkaido Medical Center For Child Health and Rehabilitation, Sapporo, Japan
| | - Tsuyoshi Tachibana
- Department of Cardiovascular Surgery, 13701Kanagawa Children's Medical Center, Yokohama, Japan
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van Kalsbeek R, Krings G, Molenschot M, Breur J. Early and midterm outcomes of bare metal stenting in small children with recurrent aortic coarctation. EUROINTERVENTION 2021; 16:e1281-e1287. [PMID: 31566574 PMCID: PMC9724864 DOI: 10.4244/eij-d-19-00157] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to report our experience with the Cook Formula stent in the treatment of (recurrent) coarctation of the aorta in children below 12 kg. METHODS AND RESULTS In vitro study of the Cook Formula 418 (8 mm) and 535 (8 and 10 mm) stents demonstrated successful down-crimping on smaller balloons and predictable fracturing patterns. Between November 2012 and January 2019, one patient with native, one patient with post-interventional and thirteen patients with post-surgical coarctation of the aorta underwent implantation of a Cook Formula stent. Patient and procedural characteristics were obtained as well as procedural success, complications, and follow-up. Median age was 4.3 months and median weight 5.5 kg. Arterial sheath size ranged from 5 to 7 Fr. In-stent diameters of 3.7 to 8.8 mm were obtained with a median residual gradient of 0 mmHg. Major complications consisted of periprocedural haemodynamic instability (n=1), dissection of the iliac artery (n=1) and non-deployment with surgical removal (n=1). Re-dilations were performed after a median interval of 24.3 months. Median follow-up was 31.7 months. CONCLUSIONS The bare metal Cook Formula stent provides a durable and effective alternative to reoperation and balloon dilatation for native as well as post-surgical aortic coarctation in children below 12 kg.
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Affiliation(s)
- Rebecca van Kalsbeek
- University Medical Centre Utrecht/Wilhelmina Children’s Hospital, Lundlaan 6, KG.01.319.0, Post Office Box 85090, 3508 AB Utrecht, the Netherlands
| | - Gregor Krings
- Paediatric Cardiology, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
| | - Mirella Molenschot
- Paediatric Cardiology, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
| | - Johannes Breur
- Paediatric Cardiology, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
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Onalan MA, Temur B, Aydın S, Basgoze S, Guzelmeric F, Odemis E, Erek E. Management of aortic arch hypoplasia in neonates and infants. J Card Surg 2020; 36:124-133. [PMID: 33225505 DOI: 10.1111/jocs.15212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Surgical management of aortic arch hypoplasia (AAH) with associated intracardiac anomalies is a challenge in newborns. We reviewed the characteristics and outcomes of neonates and infants who underwent pulmonary artery banding concomitant to arch repair and single-stage total repair at our institution. METHODS Medical records of 60 patients undergoing aortic arch reconstruction for AAH from 2014 to 2019 were retrospectively reviewed. Twenty-five patients were female (41.6%), and the age of the patients ranged from 4 to 120 days (median, 19.5 days). The patients were divided into two groups: Group 1 (23 patients) underwent pulmonary artery banding concomitant to arch repair, and Group 2 (37 patients) underwent single-stage total repair in addition to arch repair. All arch repair procedures consisted of an extended (to the midportion of the ascending aorta) patch aortoplasty. RESULTS Postoperative early mortality occurred in 12 patients, eight in Group 1 (34.8%) and four in Group 2 (10.8%). There was an early survival advantage in Group 2 (p = .019). Recoarctation occurred in 13 cases (21.6%), and 11 (18.3%) of them required reintervention (balloon angioplasty: 7, reoperation: 4). On univariate analysis, risk factors associated with death were pulmonary artery banding (hazard ratio [HR], 0.44; confidence interval [CI], 0.09-2; p = .019), prematurity (HR, 4.67; CI, 1.34-16.18; p = <.001), preoperative mechanical ventilation support requirement (HR, 0.048; CI, 0.52-6.39; p = .048), and functional single ventricle (HR, 0.43; CI, 0.1-1.86; p = .006). The mean duration of follow-up was 21.9 ± 15.1 months, and there was no late death in either group. CONCLUSION Single-stage repair of AAH with intracardiac pathologies has better results than palliation, according to survival rates and postoperative results. The use of the patch augmentation technique in AAH is valid and associated with an acceptable incidence of recurrent arch obstruction.
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Affiliation(s)
- Mehmet A Onalan
- Department of Cardiovascular Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
| | - Bahar Temur
- Department of Cardiovascular Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
| | - Selim Aydın
- Department of Cardiovascular Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
| | - Serdar Basgoze
- Department of Cardiovascular Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
| | - Fusun Guzelmeric
- Department of Anesthesiology, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
| | - Ender Odemis
- Department of Pediatric Cardiology, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
| | - Ersin Erek
- Department of Cardiovascular Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey
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Sánchez Pérez R, Tirado Requero P, Polo López L, Rey Lois J, Ramchandani Ramchandani B, Guereta Silva L, González Rocafort Á, Aroca Peinado Á. Neurological changes and outcomes of paediatric surgery of the aortic arch using selective cerebral perfusion. An Pediatr (Barc) 2020. [DOI: 10.1016/j.anpede.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sánchez Pérez R, Tirado Requero P, Polo López L, Rey Lois J, Ramchandani Ramchandani B, García-Guereta Silva L, González Rocafort Á, Aroca Peinado Á. [Neurological changes and outcomes of paediatric surgery of the aortic arch using selective cerebral perfusion]. An Pediatr (Barc) 2020; 93:305-312. [PMID: 32513600 DOI: 10.1016/j.anpedi.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The aims of this article are to analyse the neuropsychological changes in the medium-term in children subjected to aortic arch surgery using selective cerebral perfusion (SCP), as well as to detect any modifiable factors in the surgical technique that may contribute to minimising the subsequent neurological involvement. MATERIAL AND METHODS Inclusion criteria were established as: aortic arch disease operated on using SCP during the first year of life, between 10 August 2004 and 24 May 2016, biventricular physiology, and gestational age greater than 31 weeks. In the absence of a chromosomal disease, they were classified, from a neurological point of view, using the Rankin score. Children over 4-years of age were subjected to intelligence studies, including attention level, development, and psycho-lingual skills. RESULTS The study included a total of 82 patients with a mean age of 1.8 months. The mean SCP flow was 32ml/kg/min. The mean time of SCP was 31minutes. The overall mortality of the series was 14.8%. Neurological dysfunction was observed in 35.9% of patients, and the following were detected as risk factors: surgery in patients less than 10-days-old, duration of SCP greater than 40minutes, and the time required for the cooling down and/or warming-up. Attention deficit was diagnosed in 35.2% of patients greater than 5-years-old. CONCLUSIONS Patients operated on using SCP in in the first year of life required a neuropsychological follow-up, and there are modifiable surgical factors that may have an influence on neurological development.
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Affiliation(s)
- Raúl Sánchez Pérez
- Servicio de Cirugía Cardiaca Infantil y Cardiopatías Congénitas del Adulto, Hospital Universitario La Paz, Madrid, España.
| | | | - Luz Polo López
- Servicio de Cirugía Cardiaca Infantil y Cardiopatías Congénitas del Adulto, Hospital Universitario La Paz, Madrid, España
| | - Juvenal Rey Lois
- Servicio de Cirugía Cardiaca Infantil y Cardiopatías Congénitas del Adulto, Hospital Universitario La Paz, Madrid, España
| | - Bunty Ramchandani Ramchandani
- Servicio de Cirugía Cardiaca Infantil y Cardiopatías Congénitas del Adulto, Hospital Universitario La Paz, Madrid, España
| | | | - Álvaro González Rocafort
- Servicio de Cirugía Cardiaca Infantil y Cardiopatías Congénitas del Adulto, Hospital Universitario La Paz, Madrid, España
| | - Ángel Aroca Peinado
- Servicio de Cirugía Cardiaca Infantil y Cardiopatías Congénitas del Adulto, Hospital Universitario La Paz, Madrid, España
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Devlin PJ, McCrindle BW, Kirklin JK, Blackstone EH, DeCampli WM, Caldarone CA, Dodge-Khatami A, Eghtesady P, Meza JM, Gruber PJ, Guleserian KJ, Alsoufi B, Lambert LM, O'Brien JE, Austin EH, Jacobs JP, Karamlou T. Intervention for arch obstruction after the Norwood procedure: Prevalence, associated factors, and practice variability. J Thorac Cardiovasc Surg 2018; 157:684-695.e8. [PMID: 30669228 DOI: 10.1016/j.jtcvs.2018.09.130] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 08/28/2018] [Accepted: 09/12/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Arch obstruction after the Norwood procedure is common and contributes to mortality. We determined the prevalence, associated factors, and practice variability of arch reintervention and assessed whether arch reintervention is associated with mortality. METHODS From 2005 to 2017, 593 neonates in the Congenital Heart Surgeons' Society Critical Left Heart Obstruction cohort underwent a Norwood procedure. Median follow-up was 3.7 years. Multivariable parametric models, including a modulated renewal analysis, were performed. RESULTS Of the 593 neonates, 146 (25%) underwent 218 reinterventions for arch obstruction after the Norwood procedure: catheter-based (n = 168) or surgical (n = 50) at a median age of 4.3 months (quartile 1-quartile 3, 2.6-5.7). Interdigitation of the distal aortic anastomosis was protective against arch reintervention. Development of ≥ moderate tricuspid valve regurgitation and right ventricular dysfunction at any point was associated with arch reintervention. Nonsignificant variables for arch reintervention included shunt type and preoperative aortic measurements. Surgical arch reintervention was protective against arch reintervention, but transcatheter reintervention was associated with increased reintervention. Arch reintervention was not associated with increased mortality. There was wide institutional variation in incidence of arch reintervention (range, 0-40 reinterventions per 100 years patient follow-up) and in preintervention gradient (range, 0-64 mm Hg). CONCLUSIONS Interdigitation of the distal aortic anastomosis during the Norwood procedure decreased the risk of arch reintervention. Surgical arch reintervention is more definitive than transcatheter. Arch reintervention after the Norwood procedure is not associated with increased mortality. Serial surveillance for arch obstruction, integrated with changes in right ventricular function and tricuspid valve regurgitation, is recommended after the Norwood procedure to improve outcomes.
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Affiliation(s)
- Paul J Devlin
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Brian W McCrindle
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James K Kirklin
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Eugene H Blackstone
- Division of Thoracic and Cardiovascular Surgery and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - William M DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Fla
| | | | - Ali Dodge-Khatami
- Division of Pediatric Cardiac Surgery, The University of Mississippi Medical Center, Jackson, Miss
| | - Pirooz Eghtesady
- Department of Pediatric Cardiothoracic Surgery, Washington University Medical School, St Louis, Mo
| | - James M Meza
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Peter J Gruber
- Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | | | - Bahaaladin Alsoufi
- Cardiovascular Surgery, Norton Children's Hospital, University of Louisville, Louisville, Ky
| | - Linda M Lambert
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, Utah
| | - James E O'Brien
- The Ward Family Heart Center, Children's Mercy Hospitals and Clinics, Kansas City, Mo
| | - Erle H Austin
- Cardiovascular Surgery, Norton Children's Hospital, University of Louisville, Louisville, Ky
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Fla
| | - Tara Karamlou
- Division of Pediatric Cardiac Surgery, Rady Children's Hospital, San Diego, Calif
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13
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LaPar DJ, Baird CW. Surgical Considerations in Interrupted Aortic Arch. Semin Cardiothorac Vasc Anesth 2018; 22:278-284. [DOI: 10.1177/1089253218776664] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Interrupted aortic arch (IAA) is a rare congenital anomaly with several anatomical variants and is often associated with other intracardiac and/or extracardiac congenital anomalies. Historically, associated with high early mortality, outcomes for this anomaly have improved in recent eras with advances in perioperative and anesthesia management and refinements in surgical technique. This review provides a description of surgical anatomy, anatomical classifications, and associated congenital lesions as well as an examination of the perioperative and surgical management of IAA in the contemporary surgical era.
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Affiliation(s)
- Damien J. LaPar
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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14
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Corno AF, Smith P, Bezuska L, Mimic B. Is Decellularized Porcine Small Intestine Sub-mucosa Patch Suitable for Aortic Arch Repair? Front Pediatr 2018; 6:149. [PMID: 29900163 PMCID: PMC5989640 DOI: 10.3389/fped.2018.00149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/04/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction: We reviewed our experience with decellularized porcine small intestine sub-mucosa (DPSIS) patch, recently introduced for congenital heart defects. Materials and Methods: Between 10/2011 and 04/2016 a DPSIS patch was used in 51 patients, median age 1.1 months (5 days to 14.5 years), for aortic arch reconstruction (45/51 = 88.2%) or aortic coarctation repair (6/51 = 11.8%). All medical records were retrospectively reviewed, with primary endpoints interventional procedure (balloon dilatation) or surgery (DPSIS patch replacement) due to patch-related complications. Results: In a median follow-up time of 1.5 ± 1.1 years (0.6-2.3years) in 13/51 patients (25.5%) a re-intervention, percutaneous interventional procedure (5/51 = 9.8%) or re-operation (8/51 = 15.7%) was required because of obstruction in the correspondence of the DPSIS patch used to enlarge the aortic arch/isthmus, with median max velocity flow at Doppler interrogation of 4.0 ± 0.51 m/s. Two patients required surgery after failed interventional cardiology. The mean interval between DPSIS patch implantation and re-intervention (percutaneous procedure or re-operation) was 6 months (1-17 months). While there were 3 hospital deaths (3/51 = 5.9%) not related to the patch implantation, no early or late mortality occurred for the subsequent procedure required for DPSIS patch interventional cardiology or surgery. The median max velocity flow at Doppler interrogation through the aortic arch/isthmus for the patients who did not require interventional procedure or surgery was 1.7 ± 0.57 m/s. Conclusions: High incidence of re-interventions with DPSIS patch for aortic arch and/or coarctation forced us to use alternative materials (homografts and decellularized gluteraldehyde preserved bovine pericardial matrix).
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Affiliation(s)
- Antonio F Corno
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, United Kingdom.,Cardiovascular Research Center, University of Leicester, Leicester, United Kingdom
| | - Paul Smith
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, United Kingdom
| | - Laurynas Bezuska
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, United Kingdom
| | - Branko Mimic
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, United Kingdom
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15
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Wong JSY, Lee MGY, Brink J, Konstantinov IE, Brizard CP, d'Udekem Y. Are more extensive procedures warranted at the time of aortic arch reoperation? Eur J Cardiothorac Surg 2017; 52:1132-1138. [PMID: 28575303 DOI: 10.1093/ejcts/ezx166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/03/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine the early and late outcomes of patients undergoing aortic arch reoperations. METHODS The follow-up of 70 patients undergoing a second arch operation (excluding univentricular physiology) between 1979 and 2015 was reviewed. Median age at initial arch operation and second operation was 9 days (interquartile range: 5-35) and 10 months (interquartile range: 3-64), respectively. The most common indication for initial arch operation was coarctation in 79% (55/70). The most common indication for a second arch operation was arch reobstruction in 90% (63/70). RESULTS There were 2 hospital deaths (2/70, 3%) and 3 early third arch operations (3/70, 4%). Late follow-up was available in 94% (64/68) of hospital survivors. After a mean of 9 ± 7 years, there were 5 late deaths (5/64, 8%). Fifteen-year survival was 90% (95% confidence interval: 75-96). Arch reobstruction (echocardiogram gradient >25 mmHg/third operation for reobstruction) was present in 28% (18/64) and 16% (10/64) required a third arch operation. Fifteen-year freedom from arch reobstruction and third arch operation was 63% (95% confidence interval: 43-78) and 74% (95% confidence interval: 52-87), respectively. On multivariable analysis, hypoplastic arch at initial arch repair (P = 0.03) and interposition graft at second arch operation (P < 0.0001) were risk factors for third arch operation. CONCLUSIONS Patients undergoing a second arch operation have significant rates of arch reobstruction and reoperation. The high rates of arch reobstruction and third arch operation warrant more extensive procedures at the time of second arch operation, especially in patients with a hypoplastic arch. Regular long-term monitoring after arch reoperation is mandatory.
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Affiliation(s)
- Jeremy S Y Wong
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Melissa G Y Lee
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Heart Research Group, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Johann Brink
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Heart Research Group, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Heart Research Group, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Heart Research Group, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
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16
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Murtuza B, Alsoufi B. Current Readings on Surgery for the Neonate With Hypoplastic Aortic Arch. Semin Thorac Cardiovasc Surg 2017; 29:S1043-0679(17)30294-0. [PMID: 29180283 DOI: 10.1053/j.semtcvs.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 11/11/2022]
Abstract
Aortic arch hypoplasia is commonly present in neonates born with ductal-dependent coarctation of the aorta. The ideal surgical repair of neonates with proximal arch hypoplasia continues to be debated. Controversy exists about the fate of the hypoplastic proximal aortic arch following surgical repair and whether that will eventually grow to normal size upon relief of the distal obstruction or will persist as a residual lesion that can affect the long-term outlook of those patients. There is new evidence that residual proximal arch hypoplasia and the shape of the reconstructed arch both have an important impact on vascular remodeling and on the subsequent development of hypertension. Those concerns about late outcomes despite what was originally deemed a successful repair in infancy, coupled with improved cardiopulmonary bypass and cerebral perfusion techniques that allow surgeons to address proximal arch hypoplasia with low morbidity, have rekindled the debate on how to address proximal arch hypoplasia, with the aim to offer a neonatal surgery that would last for a lifetime and provide both optimal early recovery and late freedom from hypertension and related complications.
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Affiliation(s)
- Bari Murtuza
- Division of Cardiothoracic Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Bahaaldin Alsoufi
- Division of Cardiothoracic Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
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17
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De León LE, McKenzie ED. Aortic Arch Advancement and Ascending Sliding Arch Aortoplasty for Repair of Complex Primary and Recurrent Aortic Arch Obstruction. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2017; 20:63-66. [PMID: 28007067 DOI: 10.1053/j.pcsu.2016.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/14/2016] [Indexed: 11/11/2022]
Abstract
The optimal treatment of patients with complex coarctation of the aorta and hypoplastic aortic arch is controversial. Children undergoing repair of obstructive arch lesions are at lifelong risk of recurrence. Multiple techniques have been described to address complex primary and recurrent coarctation. Our approach at Texas Children's Hospital (Houston, TX) has been to address these lesions in an anatomic fashion via median sternotomy, under cardiopulmonary bypass using the techniques of aortic arch advancement and ascending sliding arch aortoplasty. Anatomic repair of complex primary or recurrent aortic obstruction is safe and produces a favorable repair with a low rate of recurrence. Both operations restore normal arch contour using native aortic tissue. The decision of which particular surgical strategy to use depends on the patient's age, anatomy, and the elasticity of the tissue.
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Affiliation(s)
- Luis E De León
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, TX
| | - E Dean McKenzie
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, TX.
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18
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Aldoss O, Goldstein BH, Danon S, Goreczny S, Gray RG, Sathanandam S, Whiteside W, Williams DA, Zampi JD. Acute and mid-term outcomes of stent implantation for recurrent coarctation of the aorta between the Norwood operation and fontan completion: A multi-center Pediatric Interventional Cardiology Early Career Society Investigation. Catheter Cardiovasc Interv 2017; 90:972-979. [DOI: 10.1002/ccd.27231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/20/2017] [Accepted: 07/16/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Osamah Aldoss
- University of Iowa Children's Hospital; Iowa city, Iowa
| | | | - Saar Danon
- St. Louis University; St. Louis, Missouri
| | | | | | | | - Wendy Whiteside
- Cincinnati Children's Hospital Medical Center; Cincinnati, Ohio
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19
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Goldberg JF. Long-term Follow-up of "Simple" Lesions--Atrial Septal Defect, Ventricular Septal Defect, and Coarctation of the Aorta. CONGENIT HEART DIS 2015; 10:466-74. [PMID: 26365715 DOI: 10.1111/chd.12298] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 01/10/2023]
Abstract
Surgery for congenital heart disease has advanced significantly in the past 50 years, such that repair of "simple" lesions, such as atrial septal defect, ventricular septal defect, and coarctation of the aorta carries minimal risk, with mortality risk much less than 1%. It was once thought successful repair of these lesions was definitively corrective. There is mounting evidence, however, that there are long-term complications after these repairs, prompting the need for continued follow-up. This review describes the current understanding of diagnosis, treatment, and long-term outcomes for these patients, with the goal of advocating for lifelong surveillance. As the perioperative care of these repairs has evolved significantly over time, so must the way in which we study these patients in the long-term.
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Affiliation(s)
- Jason F Goldberg
- Section of Pediatric Cardiology, Baylor College of Medicine, Houston, Tex, USA
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20
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Jonas RA. Management of Interrupted Aortic Arch. Semin Thorac Cardiovasc Surg 2015; 27:177-88. [DOI: 10.1053/j.semtcvs.2015.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2015] [Indexed: 11/11/2022]
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