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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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Yoneyama F, Kalustian AB, McKenzie ED, Heinle JS, Doan TT, Binsalamah Z. Long-Term Outcomes of Ascending Sliding Arch Aortoplasty. World J Pediatr Congenit Heart Surg 2024; 15:432-438. [PMID: 38465582 DOI: 10.1177/21501351241232071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background: Coarctation of the aorta can be associated with significant hypoplasia of the aortic arch. In contrast to patch aortoplasty, ascending sliding arch aortoplasty uses viable autologous tissue for potential growth in children. We reviewed the mid- to long-term outcomes of this technique. Methods: Between 2002 and 2023, 28 patients underwent ascending sliding arch aortoplasty for the patients with coarctation of the aorta (n = 22) and interrupted aortic arch (n = 2). Four patients underwent previous surgical coarctation repair at other institutions. The median patient age and body weight were 28.5 months (3 weeks to 15.6 years) and 13.4 kg (3.7-70 kg), respectively. Results: Although one patient had a recurrent nerve injury postoperatively, there were no other major morbidities or mortalities. The last follow-up echocardiography demonstrated that the mean peak velocity improved from 3.9 ± 0.6 to 0.9 ± 0.8 m/s, and the pressure gradient improved from 63.6 ± 21.5 to 7.1 ± 7.7 mm Hg. The postoperative diameters of the ascending aorta, proximal arch, distal arch, and isthmus all increased significantly. The mean postoperative length of stay was 5.9 ± 2.1 days, and the median follow-up time was 7.3 years (10 days to 20.5 years). No reoperation or catheterization-based intervention was performed for residual coarctation. Conclusions: Ascending sliding arch aortoplasty is safe and effective for treating coarctation of the aorta with aortic arch hypoplasia. This technique is applicable for children ranging in size from neonates to older children (or adolescents), recurrent coarctation cases, and provides complete relief of narrowing by utilizing viable native aortic tissue.
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Affiliation(s)
- Fumiya Yoneyama
- Department of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Alyssa B Kalustian
- Department of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - E Dean McKenzie
- Department of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey S Heinle
- Department of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Tam T Doan
- Department of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Ziyad Binsalamah
- Department of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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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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Iwaki R, Matsuhisa H, Minamisawa S, Akaike T, Hoshino M, Yagi N, Morita K, Shinohara G, Kaneko Y, Yoshitake S, Takahashi M, Tsukube T, Oshima Y. Evaluation of Ductal Tissue in Coarctation of the Aorta Using X-Ray Phase-Contrast Tomography. Pediatr Cardiol 2021; 42:654-661. [PMID: 33403434 DOI: 10.1007/s00246-020-02526-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
We assessed the histological accuracy of X-ray phase-contrast tomography (XPCT) and investigated three-dimensional (3D) ductal tissue distribution in coarctation of the aorta (CoA) specimens. We used nine CoA samples, including the aortic isthmus, ductus arteriosus (DA), and their confluences. 3D images were obtained using XPCT. After scanning, the samples were histologically evaluated using elastica van Gieson (EVG) staining and transcription factor AP-2 beta (TFAP2B) immunostaining. XPCT sectional images clearly depicted ductal tissue distribution as low-density areas. In comparison with EVG staining, the mass density of the aortic wall positively correlated with elastic fiber formation (R = 0.69, P < 0.001). TFAP2B expression was consistent with low-density area including intimal thickness on XPCT images. On 3D imaging, the distances from the DA insertion to the distal terminal of the ductal media and to the intima on the ductal side were 1.63 ± 0.22 mm and 2.70 ± 0.55 mm, respectively. In the short-axis view, the posterior extension of the ductal tissue into the aortic lumen was 79 ± 18% of the diameter of the descending aorta. In three specimens, the aortic wall was entirely occupied by ductal tissue. The ductal intima spread more distally and laterally than the ductal media. The contrast resolution of XPCT images was comparable to that of histological assessment. Based on the 3D images, we conclude that complete resection of intimal thickness, including the opposite side of the DA insertion, is required to eliminate residual ductal tissue and to prevent postoperative re-coarctation.
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Affiliation(s)
- Ryuma Iwaki
- Department of Cardiovascular Surgery, Kobe Children's Hospital, 1-6-7, Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
| | - Hironori Matsuhisa
- Department of Cardiovascular Surgery, Kobe Children's Hospital, 1-6-7, Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Susumu Minamisawa
- Department of Cell Physiology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Toru Akaike
- Department of Cell Physiology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masato Hoshino
- Japan Synchrotron Radiation Research Institute (SPring-8), 1-1-1, Kouto, Sayo-cho, Sayo-gun, Hyogo, 679-5198, Japan
| | - Naoto Yagi
- Japan Synchrotron Radiation Research Institute (SPring-8), 1-1-1, Kouto, Sayo-cho, Sayo-gun, Hyogo, 679-5198, Japan
| | - Kiyozo Morita
- Department of Cardiac Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Gen Shinohara
- Department of Cardiac Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yukihiro Kaneko
- Division of Cardiovascular Surgery, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Syuichi Yoshitake
- Division of Cardiovascular Surgery, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Masashi Takahashi
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 8050, Ikarashi 2 Nocho, Nishi-ku, Niigata, 950-2102, Japan
| | - Takuro Tsukube
- Division of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital, 1-3-1, Wakinohamakaigandori, Chuo-ku, Kobe, Hyogo, 651-0073, Japan
| | - Yoshihiro Oshima
- Department of Cardiovascular Surgery, Kobe Children's Hospital, 1-6-7, Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
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Al-Radi OO. Commentary: If it looks like a duct and it cracks like a duct, it most likely is a duct. JTCVS Tech 2020; 4:247. [PMID: 34318030 PMCID: PMC8308198 DOI: 10.1016/j.xjtc.2020.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 10/24/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Osman O Al-Radi
- Department of Surgery, Faculty of Medicine and Pediatric Cardiac Center of Excellence, King Abdulaziz University, Jeddah, Saudi Arabia
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Al Halees Z, Abdullah I. Off-pump hypoplastic aortic arch ± aortic coarctation repair via median sternotomy using a temporary shunt. Interact Cardiovasc Thorac Surg 2020; 31:748-750. [PMID: 33064793 DOI: 10.1093/icvts/ivaa175] [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: 04/24/2020] [Revised: 07/09/2020] [Accepted: 07/26/2020] [Indexed: 11/12/2022] Open
Abstract
An off-pump technique was developed to surgically manage the problem of aortic arch hypoplasia frequently associated with coarctation of the aorta and borderline size left-sided structures. The technique was successfully utilized in 5 patients adequately repairing the arch without any side effects.
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Affiliation(s)
- Zohair Al Halees
- Department of Heart Centre, Section of Congenital Heart Surgery, King Faisal Specialist Hospital & Research Center, MBC 16, Riyadh 11211, Saudi Arabia
| | - Ibrahim Abdullah
- Department of Heart Centre, Section of Congenital Heart Surgery, King Faisal Specialist Hospital & Research Center, MBC 16, Riyadh 11211, Saudi Arabia
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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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Abstract
Summary
Objectives
Various surgical strategies have been reported for the treatment of aortic coarctation with hypoplastic aortic arch, including simple resection and end-to-end anastomosis as well as various forms of patch augmentation. These techniques are limited by inadequate relief of arch obstruction and use of patch material predisposed to recurrent obstruction or aneurysm formation. We report our experience with autologous aortic arch reconstruction in isolated and combined lesions, a technique that relieves even complex forms of arch reconstruction without patch material.
Methods
We retrospectively analyzed our institutional experience with autologous aortic arch reconstruction in isolated and combined cardiac lesions from November 2009 to December 2016. Study endpoints were procedural success, incidence of procedure-related complications, need for re-interventions, and survival.
Results
In total, 54 patients underwent total autologous aortic arch reconstruction during the study period. Thereof, 13 (24%) had isolated arch obstruction and 41 (76%) had combined cardiac lesions. The majority of procedures were performed in the neonatal period (72%), median age was 8 days (range: 1 day to 4.3 years). Body weight ranged from 2.2 to 16.5 kg (median: 3.7 kg). There was one (1.9%) procedure-related early reoperation for bronchial obstruction. No repeat interventions (dilatation or re-operation) were observed. One patient with syndromic disease died on postoperative day 20 due to sepsis (1.9% in-hospital mortality rate). No late deaths were observed. Median follow-up was 23 months.
Conclusion
Autologous aortic arch reconstruction is a safe and effective surgical technique for the treatment of aortic arch obstruction in isolated and complex cardiac lesions. It is associated with an extremely low re-intervention rate and a low overall complication rate.
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Tsang V, Haapanen H, Neijenhuis R. Aortic Coarctation/Arch Hypoplasia Repair: How Small Is Too Small. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2019; 22:10-13. [PMID: 31027557 DOI: 10.1053/j.pcsu.2019.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 02/26/2019] [Indexed: 06/09/2023]
Abstract
Aortic coarctation/arch hypoplasia is a relatively common congenital heart disease that leads to severe cardiovascular complications if left untreated. During the modern era, the mortality of the primary surgical repair is very low but the long-term issues, such as recurrent coarctation/arch reobstruction and hypertension, are still significant challenges. The former is related to the surgical repair performed particularly in the management of the smallish distal aortic arch, and for the latter, despite the "successful" repair of the aortic coarctation, the intrinsic vascular anomaly remains a significant long-term morbidity.
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Affiliation(s)
- Victor Tsang
- Cardiothoracic Surgery Unit, Great Ormond Street Hospital for Children, London, United Kingdom.
| | - Henri Haapanen
- Department of Surgery, North Karelia Central Hospital, Joensuu, Finland
| | - Ralph Neijenhuis
- Cardiothoracic Surgery Unit, Great Ormond Street Hospital for Children, London, United Kingdom
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Bichell D. Neonatal Arch Reconstruction: Guiding Principles, Some Misguided Ones, and a Few More That Don't Matter. Semin Thorac Cardiovasc Surg 2017; 29:S1043-0679(17)30301-5. [PMID: 29197613 DOI: 10.1053/j.semtcvs.2017.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 11/11/2022]
Affiliation(s)
- David Bichell
- Monroe Carell, Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, Tennessee.
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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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Slesnick TC. Role of Computational Modelling in Planning and Executing Interventional Procedures for Congenital Heart Disease. Can J Cardiol 2017; 33:1159-1170. [PMID: 28843327 DOI: 10.1016/j.cjca.2017.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/26/2017] [Accepted: 05/27/2017] [Indexed: 10/19/2022] Open
Abstract
Increasingly, computational modelling and numerical simulations are used to help plan complex surgical and interventional cardiovascular procedures in children and young adults with congenital heart disease. From its origins more than 30 years ago, surgical planning with analysis of flow hemodynamics and energy loss/efficiency has helped design and implement many modifications to existing techniques. On the basis of patient-specific medical imaging, surgical planning allows accurate model production that can then be manipulated in a virtual surgical environment, with the proposed solutions finally tested with advanced computational fluid dynamics to evaluate the results. Applications include a broad range of congenital heart disease, including patients with single-ventricle anatomy undergoing staged palliation, those with arch obstruction, with double outlet right ventricle, or with tetralogy of Fallot. In the present work, we focus on clinical applications of this exciting field. We describe the framework for these techniques, including brief descriptions of the engineering principles applied and the interaction between "benchtop" data with medical decision-making. We highlight some early insights learned from pioneers over the past few decades, including refinements in Fontan baffle geometries and configurations. Finally, we offer a glimpse into exciting advances that are presently being explored, including use of modelling for transcatheter interventions. In this era of personalized medicine, computational modelling and surgical planning allows patient-specific tailoring of interventions to optimize clinical outcomes.
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Affiliation(s)
- Timothy C Slesnick
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
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