Chinese expert consensus on surgical treatment of congenital heart disease (11): Coarctation of the aorta and interrupted aortic arch_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHANG Haibo ¹ ,  LI Shoujun ²

1. Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, P.R.China;
2. Department of Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

ZHANG Haibo, Email: zhanghaibosh@126.com; LI Shoujun, Email: drlishoujun@yahoo.com

Keywords：

Coarctation of the aorta; interrupted aortic arch; surgical treatment; expert consensus

DOI：

10.7507/1007-4848.202008010

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Coarctation of the aorta and interrupted aortic arch are congenital anomalies affecting the aortic arch. Because of the poor natural prognosis, many patients will need early surgical repair or even emergency surgery. With the improvement of the surgical techniques, cardiopulmonary bypass techniques and perioperative intensive care, surgical mortality has now dramatically decreased. However, aortic arch restenosis, left ventricular outflow tract obstruction and long-term hypertension are problems that may be still encountered during the follow-up period. By reviewing large amounts of literature and discussing among experts, we achieved a consensus on many aspects of the management strategy. We hope this consensus will help Chinese colleagues further improve the overall surgical outcomes of coarctation of aorta and interrupted aortic arch.

Citation： ZHANG Haibo, LI Shoujun. Chinese expert consensus on surgical treatment of congenital heart disease (11): Coarctation of the aorta and interrupted aortic arch. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(11): 1255-1261. doi: 10.7507/1007-4848.202008010 Copy

1.	Backer CL, Mavroudis C. Congenital Heart Surgery Nomenclature and Database Project: patent ductus arteriosus, coarctation of the aorta, interrupted aortic arch. Ann Thorac Surg, 2000, 69(4 Suppl): S298-307.
2.	Kouchoukos NT, Blackstone EH, Hanley FL, et al. Kirklin/Barrat-Boyes Cardiac Surgery, 3^rd edition. Netherlands: Saunders, 2003.
3.	Campbell M. Natural history of coarctation of the aorta. Br Heart J, 1970, 32(5): 633-640.
4.	Collins-Nakai RL, Dick M, Parisi-Buckley L, et al. Interrupted aortic arch in infancy. J Pediatr, 1976, 88(6): 959-962.
5.	St Louis JD, Harvey BA, Menk JS, et al. Mortality and operative management for patients undergoing repair of coarctation of the aorta: A retrospective review of the pediatric cardiac care consortium. World J Pediatr Congenit Heart Surg, 2015, 6(3): 431-437.
6.	Lacour-Gayet F, Bruniaux J, Serraf A, et al. Hypoplastic transverse arch and coarctation in neonates. Surgical reconstruction of the aortic arch: a study of sixty-six patients. J Thorac Cardiovasc Surg, 1990, 100(6): 808-816.
7.	Elgamal MA, McKenzie ED, Fraser CD. Aortic arch advancement: the optimal one-stage approach for surgical management of neonatal coarctation with arch hypoplasia. Ann Thorac Surg, 2002, 73(4): 1267-1272.
8.	莫绪明. 主动脉弓发育不良诊治焦点解析. 中华小儿外科杂志, 2018, 39(8): 561-563.
9.	Kaushal S, Backer CL, Patel JN, et al. Coarctation of the aorta: midterm outcomes of resection with extended end-to-end anastomosis. Ann Thorac Surg, 2009, 88(6): 1932-1938.
10.	Shi G, Chen H, Jinghao Z, et al. Primary complete repair of interrupted aortic arch with associated lesions in infants. J Card Surg, 2014, 29(5): 686-691.
11.	崔虎军, 陈寄梅, 庄建, 等. 主动脉弓中断的外科治疗及早中期结果. 中华外科杂志, 2018, 56(12): 916-921.
12.	Brown ML, Burkhart HM, Connolly HM, et al. Coarctation of the aorta: lifelong surveillance is mandatory following surgical repair. J Am Coll Cardiol, 2013, 62(11): 1020-1025.
13.	Callahan CP, Saudek D, Creighton S, et al. Proximal arch in left thoracotomy repair of neonatal and infant coarctation-how small is too small? World J Pediatr Congenit Heart Surg, 2019, 10(4): 469-474.
14.	Jegatheeswaran A, McCrindle BW, Blackstone EH, et al. Persistent risk of subsequent procedures and mortality in patients after interrupted aortic arch repair: a Congenital Heart Surgeons' Society study. J Thorac Cardiovasc Surg, 2010, 140(5): 1059-1075.
15.	McCrindle BW, Tchervenkov CI, Konstantinov IE, et al. Risk factors associated with mortality and interventions in 472 neonates with interrupted aortic arch: a Congenital Heart Surgeons Society study. J Thorac Cardiovasc Surg, 2005, 129(2): 343-350.
16.	Walters HL, Ionan CE, Thomas RL, et al. Single-stage versus 2-stage repair of coarctation of the aorta with ventricular septal defect. J Thorac Cardiovasc Surg, 2008, 135(4): 754-761.
17.	Oosterhof T, Azakie A, Freedom RM, et al. Associated factors and trends in outcomes of interrupted aortic arch. Ann Thorac Surg, 2004, 78(5): 1696-1702.
18.	Fulton JO, Mas C, Brizard CP, et al. Does left ventricular outflow tract obstruction influence outcome of interrupted aortic arch repair? Ann Thorac Surg, 1999, 67(1): 177-181.
19.	Brown JW, Ruzmetov M, Okada Y, et al. Outcomes in patients with interrupted aortic arch and associated anomalies: a 20-year experience. Eur J Cardiothorac Surg, 2006, 29(5): 666-673.
20.	Riggs KW, Tweddell JS. How small is too small? Decision-making and management of the small aortic root in the setting of interrupted aortic arch. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2019, 22: 21-26.
21.	Lee MGY, Millar J, Rose E, et al. Laryngeal ultrasound detects a high incidence of vocal cord paresis after aortic arch repair in neonates and young children. J Thorac Cardiovasc Surg, 2018, 155(6): 2579-2587.
22.	Ungerleider RM, Pasquali SK, Welke KF, et al. Contemporary patterns of surgery and outcomes for aortic coarctation: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg, 2013, 145(1): 150-157.
23.	Mery CM, Guzmán-Pruneda FA, Carberry KE, et al. Aortic arch advancement for aortic coarctation and hypoplastic aortic arch in neonates and infants. Ann Thorac Surg, 2014, 98(2): 625-633.
24.	Lee MG, Brink J, Galati JC, et al. End-to-side repair for aortic arch lesions offers excellent chances to reach adulthood without reoperation. Ann Thorac Surg, 2014, 98(4): 1405-1411.
25.	莫绪明, 孙剑, 彭卫, 等. 婴幼儿主动脉弓中断合并心内畸形胸骨正中切口一期手术治疗. 中华胸心血管外科杂志, 2012, 28(12): 708-711.
26.	Tulzer A, Mair R, Kreuzer M, et al. Outcome of aortic arch reconstruction in infants with coarctation: Importance of operative approach. J Thorac Cardiovasc Surg, 2016, 152(6): 1506-1513.
27.	Brown JW, Ruzmetov M, Hoyer MH, et al. Recurrent coarctation: is surgical repair of recurrent coarctation of the aorta safe and effective? Ann Thorac Surg, 2009, 88(6): 1923-1930.
28.	Sakurai T, Stickley J, Stümper O, et al. Repair of isolated aortic coarctation over two decades: impact of surgical approach and associated arch hypoplasia. Interact Cardiovasc Thorac Surg, 2012, 15(5): 865-870.
29.	Dias MQ, Barros A, Leite-Moreira A, et al. Risk factors for recoarctation and mortality in infants submitted to aortic coarctation repair: A systematic review. Pediatr Cardiol, 2020, 41(3): 561-575.
30.	Dodge-Khatami A, Backer CL, Mavroudis C. Risk factors for recoarctation and results of reoperation: a 40-year review. J Card Surg, 2000, 15(6): 369-377.
31.	Knott-Craig CJ, Elkins RC, Ward KE, et al. Neonatal coarctation repair. Influence of technique on late results. Circulation, 1993, 88(5 Pt 2): Ⅱ198-Ⅱ204.
32.	McElhinney DB, Yang SG, Hogarty AN, et al. Recurrent arch obstruction after repair of isolated coarctation of the aorta in neonates and young infants: is low weight a risk factor? J Thorac Cardiovasc Surg, 2001, 122(5): 883-890.
33.	Wu JL, Leung MP, Karlberg J, et al. Surgical repair of coarctation of the aorta in neonates: factors affecting early mortality and re-coarctation. Cardiovasc Surg, 1995, 3(6): 573-578.
34.	Tong F, Li ZQ, Li L, et al. The follow-up surgical results of coarctation of the aorta procedures in a cohort of Chinese children from a single institution. Heart Lung Circ, 2014, 23(4): 339-346.
35.	Brown ML, Burkhart HM, Connolly HM, et al. Late outcomes of reintervention on the descending aorta after repair of aortic coarctation. Circulation, 2010, 122(11 Suppl): S81-S84.
36.	Feltes TF, Bacha E, Beekman RH, et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation, 2011, 123(22): 2607-2652.
37.	Liu JY, Kowalski R, Jones B, et al. Moderately hypoplastic arches: do they reliably grow into adulthood after conventional coarctation repair? Interact Cardiovasc Thorac Surg, 2010, 10(4): 582-586.
38.	Wong JSY, Lee MGY, Brink J, et al. Are more extensive procedures warranted at the time of aortic arch reoperation? Eur J Cardiothorac Surg, 2017, 52(6): 1132-1138.
39.	Mery CM, Khan MS, Guzmán-Pruneda FA, et al. Contemporary results of surgical repair of recurrent aortic arch obstruction. Ann Thorac Surg, 2014, 98(1): 133-140.
40.	Alsoufi B, Schlosser B, McCracken C, et al. Selective management strategy of interrupted aortic arch mitigates left ventricular outflow tract obstruction risk. J Thorac Cardiovasc Surg, 2016, 151(2): 412-420.
41.	Canniffe C, Ou P, Walsh K, et al. Hypertension after repair of aortic coarctation--a systematic review. Int J Cardiol, 2013, 167(6): 2456-2461.
42.	Lee MGY, Allen SL, Koleff J, et al. Impact of arch reobstruction and early hypertension on late hypertension after coarctation repair. Eur J Cardiothorac Surg, 2018, 53(3): 531-537.
43.	Giordano U, Chinali M, Franceschini A, et al. Impact of complex congenital heart disease on the prevalence of arterial hypertension after aortic coarctation repair. Eur J Cardiothorac Surg, 2019, 55(3): 559-563.
44.	Bruse JL, Khushnood A, McLeod K, et al. How successful is successful? Aortic arch shape after successful aortic coarctation repair correlates with left ventricular function. J Thorac Cardiovasc Surg, 2017, 153(2): 418-427.
45.	Hager A, Kanz S, Kaemmerer H, et al. Coarctation Long-term Assessment (COALA): significance of arterial hypertension in a cohort of 404 patients up to 27 years after surgical repair of isolated coarctation of the aorta, even in the absence of restenosis and prosthetic material. J Thorac Cardiovasc Surg, 2007, 134(3): 738-745.
46.	Lee MG, Allen SL, Kawasaki R, et al. High prevalence of hypertension and end-organ damage late after coarctation repair in normal arches. Ann Thorac Surg, 2015, 100(2): 647-653.
47.	Ramachandran P, Khoury PR, Beekman RH, et al. Preoperative aortic arch size and late outcome after coarctation repair by lateral thoracotomy. Ann Thorac Surg, 2018, 106(2): 575-580.
48.	Ma ZL, Yan J, Li SJ, et al. Coarctation of the aorta with aortic arch hypoplasia: Midterm outcomes of aortic arch reconstruction with autologous pulmonary artery patch. Chin Med J (Engl), 2017, 130(23): 2802-2807.
49.	Hussein A, Iyengar AJ, Jones B, et al. Twenty-three years of single-stage end-to-side anastomosis repair of interrupted aortic arches. J Thorac Cardiovasc Surg, 2010, 139(4): 942-947.
50.	Li Z, Li B, Fan X, et al. Surgical treatment of interrupted aortic arch associated with ventricular septal defect and patent ductus arteriosus in patients over one year of age. Chin Med J (Engl), 2014, 127(9): 1684-1690.
51.	Rajbanshi BG, Joshi D, Pradhan S, et al. Primary surgical repair of coarctation of the aorta in adolescents and adults: intermediate results and consequences of hypertension. Eur J Cardiothorac Surg, 2019, 55(2): 323-330.

1. Backer CL, Mavroudis C. Congenital Heart Surgery Nomenclature and Database Project: patent ductus arteriosus, coarctation of the aorta, interrupted aortic arch. Ann Thorac Surg, 2000, 69(4 Suppl): S298-307.
2. Kouchoukos NT, Blackstone EH, Hanley FL, et al. Kirklin/Barrat-Boyes Cardiac Surgery, 3^rd edition. Netherlands: Saunders, 2003.
3. Campbell M. Natural history of coarctation of the aorta. Br Heart J, 1970, 32(5): 633-640.
4. Collins-Nakai RL, Dick M, Parisi-Buckley L, et al. Interrupted aortic arch in infancy. J Pediatr, 1976, 88(6): 959-962.
5. St Louis JD, Harvey BA, Menk JS, et al. Mortality and operative management for patients undergoing repair of coarctation of the aorta: A retrospective review of the pediatric cardiac care consortium. World J Pediatr Congenit Heart Surg, 2015, 6(3): 431-437.
6. Lacour-Gayet F, Bruniaux J, Serraf A, et al. Hypoplastic transverse arch and coarctation in neonates. Surgical reconstruction of the aortic arch: a study of sixty-six patients. J Thorac Cardiovasc Surg, 1990, 100(6): 808-816.
7. Elgamal MA, McKenzie ED, Fraser CD. Aortic arch advancement: the optimal one-stage approach for surgical management of neonatal coarctation with arch hypoplasia. Ann Thorac Surg, 2002, 73(4): 1267-1272.
8. 莫绪明. 主动脉弓发育不良诊治焦点解析. 中华小儿外科杂志, 2018, 39(8): 561-563.
9. Kaushal S, Backer CL, Patel JN, et al. Coarctation of the aorta: midterm outcomes of resection with extended end-to-end anastomosis. Ann Thorac Surg, 2009, 88(6): 1932-1938.
10. Shi G, Chen H, Jinghao Z, et al. Primary complete repair of interrupted aortic arch with associated lesions in infants. J Card Surg, 2014, 29(5): 686-691.
11. 崔虎军, 陈寄梅, 庄建, 等. 主动脉弓中断的外科治疗及早中期结果. 中华外科杂志, 2018, 56(12): 916-921.
12. Brown ML, Burkhart HM, Connolly HM, et al. Coarctation of the aorta: lifelong surveillance is mandatory following surgical repair. J Am Coll Cardiol, 2013, 62(11): 1020-1025.
13. Callahan CP, Saudek D, Creighton S, et al. Proximal arch in left thoracotomy repair of neonatal and infant coarctation-how small is too small? World J Pediatr Congenit Heart Surg, 2019, 10(4): 469-474.
14. Jegatheeswaran A, McCrindle BW, Blackstone EH, et al. Persistent risk of subsequent procedures and mortality in patients after interrupted aortic arch repair: a Congenital Heart Surgeons' Society study. J Thorac Cardiovasc Surg, 2010, 140(5): 1059-1075.
15. McCrindle BW, Tchervenkov CI, Konstantinov IE, et al. Risk factors associated with mortality and interventions in 472 neonates with interrupted aortic arch: a Congenital Heart Surgeons Society study. J Thorac Cardiovasc Surg, 2005, 129(2): 343-350.
16. Walters HL, Ionan CE, Thomas RL, et al. Single-stage versus 2-stage repair of coarctation of the aorta with ventricular septal defect. J Thorac Cardiovasc Surg, 2008, 135(4): 754-761.
17. Oosterhof T, Azakie A, Freedom RM, et al. Associated factors and trends in outcomes of interrupted aortic arch. Ann Thorac Surg, 2004, 78(5): 1696-1702.
18. Fulton JO, Mas C, Brizard CP, et al. Does left ventricular outflow tract obstruction influence outcome of interrupted aortic arch repair? Ann Thorac Surg, 1999, 67(1): 177-181.
19. Brown JW, Ruzmetov M, Okada Y, et al. Outcomes in patients with interrupted aortic arch and associated anomalies: a 20-year experience. Eur J Cardiothorac Surg, 2006, 29(5): 666-673.
20. Riggs KW, Tweddell JS. How small is too small? Decision-making and management of the small aortic root in the setting of interrupted aortic arch. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2019, 22: 21-26.
21. Lee MGY, Millar J, Rose E, et al. Laryngeal ultrasound detects a high incidence of vocal cord paresis after aortic arch repair in neonates and young children. J Thorac Cardiovasc Surg, 2018, 155(6): 2579-2587.
22. Ungerleider RM, Pasquali SK, Welke KF, et al. Contemporary patterns of surgery and outcomes for aortic coarctation: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg, 2013, 145(1): 150-157.
23. Mery CM, Guzmán-Pruneda FA, Carberry KE, et al. Aortic arch advancement for aortic coarctation and hypoplastic aortic arch in neonates and infants. Ann Thorac Surg, 2014, 98(2): 625-633.
24. Lee MG, Brink J, Galati JC, et al. End-to-side repair for aortic arch lesions offers excellent chances to reach adulthood without reoperation. Ann Thorac Surg, 2014, 98(4): 1405-1411.
25. 莫绪明, 孙剑, 彭卫, 等. 婴幼儿主动脉弓中断合并心内畸形胸骨正中切口一期手术治疗. 中华胸心血管外科杂志, 2012, 28(12): 708-711.
26. Tulzer A, Mair R, Kreuzer M, et al. Outcome of aortic arch reconstruction in infants with coarctation: Importance of operative approach. J Thorac Cardiovasc Surg, 2016, 152(6): 1506-1513.
27. Brown JW, Ruzmetov M, Hoyer MH, et al. Recurrent coarctation: is surgical repair of recurrent coarctation of the aorta safe and effective? Ann Thorac Surg, 2009, 88(6): 1923-1930.
28. Sakurai T, Stickley J, Stümper O, et al. Repair of isolated aortic coarctation over two decades: impact of surgical approach and associated arch hypoplasia. Interact Cardiovasc Thorac Surg, 2012, 15(5): 865-870.
29. Dias MQ, Barros A, Leite-Moreira A, et al. Risk factors for recoarctation and mortality in infants submitted to aortic coarctation repair: A systematic review. Pediatr Cardiol, 2020, 41(3): 561-575.
30. Dodge-Khatami A, Backer CL, Mavroudis C. Risk factors for recoarctation and results of reoperation: a 40-year review. J Card Surg, 2000, 15(6): 369-377.
31. Knott-Craig CJ, Elkins RC, Ward KE, et al. Neonatal coarctation repair. Influence of technique on late results. Circulation, 1993, 88(5 Pt 2): Ⅱ198-Ⅱ204.
32. McElhinney DB, Yang SG, Hogarty AN, et al. Recurrent arch obstruction after repair of isolated coarctation of the aorta in neonates and young infants: is low weight a risk factor? J Thorac Cardiovasc Surg, 2001, 122(5): 883-890.
33. Wu JL, Leung MP, Karlberg J, et al. Surgical repair of coarctation of the aorta in neonates: factors affecting early mortality and re-coarctation. Cardiovasc Surg, 1995, 3(6): 573-578.
34. Tong F, Li ZQ, Li L, et al. The follow-up surgical results of coarctation of the aorta procedures in a cohort of Chinese children from a single institution. Heart Lung Circ, 2014, 23(4): 339-346.
35. Brown ML, Burkhart HM, Connolly HM, et al. Late outcomes of reintervention on the descending aorta after repair of aortic coarctation. Circulation, 2010, 122(11 Suppl): S81-S84.
36. Feltes TF, Bacha E, Beekman RH, et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation, 2011, 123(22): 2607-2652.
37. Liu JY, Kowalski R, Jones B, et al. Moderately hypoplastic arches: do they reliably grow into adulthood after conventional coarctation repair? Interact Cardiovasc Thorac Surg, 2010, 10(4): 582-586.
38. Wong JSY, Lee MGY, Brink J, et al. Are more extensive procedures warranted at the time of aortic arch reoperation? Eur J Cardiothorac Surg, 2017, 52(6): 1132-1138.
39. Mery CM, Khan MS, Guzmán-Pruneda FA, et al. Contemporary results of surgical repair of recurrent aortic arch obstruction. Ann Thorac Surg, 2014, 98(1): 133-140.
40. Alsoufi B, Schlosser B, McCracken C, et al. Selective management strategy of interrupted aortic arch mitigates left ventricular outflow tract obstruction risk. J Thorac Cardiovasc Surg, 2016, 151(2): 412-420.
41. Canniffe C, Ou P, Walsh K, et al. Hypertension after repair of aortic coarctation--a systematic review. Int J Cardiol, 2013, 167(6): 2456-2461.
42. Lee MGY, Allen SL, Koleff J, et al. Impact of arch reobstruction and early hypertension on late hypertension after coarctation repair. Eur J Cardiothorac Surg, 2018, 53(3): 531-537.
43. Giordano U, Chinali M, Franceschini A, et al. Impact of complex congenital heart disease on the prevalence of arterial hypertension after aortic coarctation repair. Eur J Cardiothorac Surg, 2019, 55(3): 559-563.
44. Bruse JL, Khushnood A, McLeod K, et al. How successful is successful? Aortic arch shape after successful aortic coarctation repair correlates with left ventricular function. J Thorac Cardiovasc Surg, 2017, 153(2): 418-427.
45. Hager A, Kanz S, Kaemmerer H, et al. Coarctation Long-term Assessment (COALA): significance of arterial hypertension in a cohort of 404 patients up to 27 years after surgical repair of isolated coarctation of the aorta, even in the absence of restenosis and prosthetic material. J Thorac Cardiovasc Surg, 2007, 134(3): 738-745.
46. Lee MG, Allen SL, Kawasaki R, et al. High prevalence of hypertension and end-organ damage late after coarctation repair in normal arches. Ann Thorac Surg, 2015, 100(2): 647-653.
47. Ramachandran P, Khoury PR, Beekman RH, et al. Preoperative aortic arch size and late outcome after coarctation repair by lateral thoracotomy. Ann Thorac Surg, 2018, 106(2): 575-580.
48. Ma ZL, Yan J, Li SJ, et al. Coarctation of the aorta with aortic arch hypoplasia: Midterm outcomes of aortic arch reconstruction with autologous pulmonary artery patch. Chin Med J (Engl), 2017, 130(23): 2802-2807.
49. Hussein A, Iyengar AJ, Jones B, et al. Twenty-three years of single-stage end-to-side anastomosis repair of interrupted aortic arches. J Thorac Cardiovasc Surg, 2010, 139(4): 942-947.
50. Li Z, Li B, Fan X, et al. Surgical treatment of interrupted aortic arch associated with ventricular septal defect and patent ductus arteriosus in patients over one year of age. Chin Med J (Engl), 2014, 127(9): 1684-1690.
51. Rajbanshi BG, Joshi D, Pradhan S, et al. Primary surgical repair of coarctation of the aorta in adolescents and adults: intermediate results and consequences of hypertension. Eur J Cardiothorac Surg, 2019, 55(2): 323-330.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Chinese expert consensus on surgical treatment of congenital heart disease (11): Coarctation of the aorta and interrupted aortic arch

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content