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Deniz E, Bobylev D, Krüger H, Salman J, Zubarevich A, Martens A, Kaufeld T, Schmack B, Weymann A, Ruhparwar A, Popov AF, Helms F. The Fate of the Aorta after Coarctation Repair: Open Surgical Replacement of Descending Aorta in a High-Volume Unit. J Clin Med 2024; 13:5345. [PMID: 39336832 PMCID: PMC11432251 DOI: 10.3390/jcm13185345] [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: 08/14/2024] [Revised: 09/05/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
Objectives: Complications after aortic coarctation repair are associated with high mortality and require surgical or endovascular reintervention. For patients unsuitable for endovascular therapies, reoperation remains the only therapeutic option. However, surgical experience and up-to-date follow-up data concerning this overall rare entity in the spectrum of aortic reoperations are still highly limited. Thus, the aim of this study was to analyze the short-term outcomes and long-term survival of patients undergoing surgical descending aorta repair after previous coarctation repair in a high-volume unit. Methods: We present a retrospective single-center analysis of 25 patients who underwent open descending aorta replacement after initial coarctation repair. The surgical history, concomitant cardiovascular malformations, and preoperative characteristics as well as postoperative complications and long-term survival were analyzed. Results: The mean age at operation was 45.4 ± 12.8 years. A proportion of 68% (n = 17) of the patients were male. The most common complication necessitating reoperation after coarctation repair was aneurysm formation (68%) and re-stenosis (16%). The average time between initial repair and reoperation was 26.3 ± 9.9 years. Technical success was achieved in all the operations, while recurrent nerve damage (24%) and bleeding requiring rethoracotomy (20%) were identified as the most common perioperative complications. The one-year mortality was 0% and the overall long-term survival was 88% at 15 years. Conclusions: Open surgical descending aorta replacement can be performed safely and with excellent survival outcomes even in the challenging subgroup of patients after previous coarctation repair. Thus, reoperation should be considered a feasible approach for patients who are unsuitable for endovascular therapies. Nonetheless, concomitant cardiovascular anomalies and frequent preoperations may complicate the redo operation in this patient population.
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Affiliation(s)
- Ezin Deniz
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Dmitry Bobylev
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Heike Krüger
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Jawad Salman
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Alina Zubarevich
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Andreas Martens
- Clinic for Cardiac Surgery, University Clinic Oldenburg, 26133 Oldenburg, Germany
| | - Tim Kaufeld
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Bastian Schmack
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Alexander Weymann
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Arjang Ruhparwar
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Aron-Frederik Popov
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Florian Helms
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
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Krylova A, Svobodov A, Tumanyan M, Levchenko E, Kotov S, Butrim Y, Shvartz V. Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis. Life (Basel) 2023; 13:2282. [PMID: 38137882 PMCID: PMC10744862 DOI: 10.3390/life13122282] [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: 10/25/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Surgical treatment of aortic coarctation in low-birth-weight (LBW) neonates is associated with risks of higher hospital mortality rates and recoarctation development in the long-term. The goal of our study was to compare the results of surgical treatment of aortic coarctation in LBW neonates and normal-weight patients, to identify predictors of recoarctation in the long-term among LBW patients. MATERIALS AND METHODS A retrospective study was performed to analyse the patients who had undergone resection of isolated aortic coarctation between 2005 and 2022. Overall analysis included 521 patients under the age of 30 days, 89 LBW patients and 432 patients with normal body weight. Propensity score matching (PSM) was performed at a ratio of 1:1 for the statistical adjustment of original patients' data in both groups. RESULTS All patients underwent standard resection of aortic coarctation with extended end-to-end anastomosis. Hospital mortality among LBW patients was 8% and in patients with normal weight the mortality amounted to 1% (p = 0.030). LBW patients were transferred to other hospitals more often than normal-weight patients who were more often discharged (p < 0.001). In the long-term, period mortality was not statistically significantly different (p = 0.801). The freedom from reoperation in the group of normal-weight children was 87%, whereas in the LBW patients the rate was 63% (log rank test, p = 0.104). In the multivariate regression model, the most significant risk factors for reoperation were as follows: preoperative inotropes administration (OR (95% CI) 4.369 (1.316-14.51)) and pressure gradient across aortic arch before discharge (OR (95% CI) 1.081 (1.014-1.153)). CONCLUSIONS Hospital mortality was higher among LBW patients (p = 0.030). There was a statistical trend of differences in reoperation rates: in the long-term among LBW patients, a higher reintervention probability remains. Moreover, the LBW group initially had more severe clinical condition in terms of cardiac failure and impaired renal function. Factors associated with the risk of recoarctation were preoperative inotropes infusion and pressure gradient across aortic before discharge.
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Affiliation(s)
- Aleksandra Krylova
- The Department of Intensive Cardiology for Congenital Heart Diseases of Premature Neonates and Infants, Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow 121552, Russia
| | - Andrey Svobodov
- The Department of Intensive Cardiology for Congenital Heart Diseases of Premature Neonates and Infants, Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow 121552, Russia
| | - Margarita Tumanyan
- The Department of Intensive Cardiology for Congenital Heart Diseases of Premature Neonates and Infants, Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow 121552, Russia
| | - Elena Levchenko
- The Department of Intensive Cardiology for Congenital Heart Diseases of Premature Neonates and Infants, Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow 121552, Russia
| | - Sergey Kotov
- The Department of Intensive Cardiology for Congenital Heart Diseases of Premature Neonates and Infants, Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow 121552, Russia
| | - Yuliya Butrim
- The Department of Intensive Cardiology for Congenital Heart Diseases of Premature Neonates and Infants, Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow 121552, Russia
| | - Vladimir Shvartz
- The Department of Surgical Treatment for Interactive Pathology, Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow 121552, Russia
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