Results of surgical treatment for 79 patients with aortic coarctation combined with complex anomalies: A retrospective analysis in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Xiang ^1,2 , WEI Huijin ^1,2 , MA Li ^1,2 , ZOU Minghui ^1,2 , CHEN Weidan ^1,2 ,  CHEN Xinxin ^1,2

1. Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, P. R. China;
2. Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou, 510623, P. R. China;

Corresponding author：

CHEN Xinxin, Email: zingerchen@163.com

Keywords：

Congenital heart disease; coarctation of the aorta; complex cardiac anomalies; surgical treatment; outcome

DOI：

10.7507/1007-4848.202011068

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Objective To summarize the results of surgical treatment for 79 patients with coarctation of the aorta (CoA) combined with complex anomalies (CA) in recent years.Methods The data from 79 patients with CoA combined with CA admitted to Guangzhou Women and Children's Medical Center between January 19, 2010 and September 7, 2017 were collected and analyzed. There were 52 males and 27 females. The median age was 71 days, and the median weight was 4.3 kg. There were 26 patients combined with tracheostenosis and 7 patients with preoperative tracheal intubation. Extended end-to-side anastomosis was used to correct the CoA, and the associated cardiac abnormalities were treated simultaneously by an incision through median sternotomy. All operations were performed by the same group of surgeons.Results The median deep hypothermic circulatory arrest was 18 (13-28) minutes, the median aorta cross-clamp time was 62 (15-199) minutes, the median cardiopulmonary bypass time was 145 (71-674) minutes, the median ventilation time was 72 (9-960) hours, the median length of ICU stay was 144 (12-1 944) hours, and the median length of hospital stay was 24 (2-93) days. Early death occurred in 9 patients and late death occurred in 5 patients. Reoperation occurred in 28 patients and recoarctation developed in 10 patients. After operation, transcoarctation gradient was reduced, and the transcutaneous oxygen saturation, C-reactive protein (CRP), lactate and creatinine were increased. Compared to the survival group, both preoperative and postoperative transcutaneous oxygen saturation were worse and the postoperative levels of plasma brain natriuretic peptide (BNP) and CRP were higher in the death group.Conclusion Correcting the CoA and the associated CA simultaneously with extended end-to-side anastomosis by an incision through median sternotomy is effective and safe, and the outcomes of immediate and medial-term are satisfactory. Improving oxygenation and limiting elevation of BNP and CRP levels may reduce the death rate.

Citation： LIU Xiang, WEI Huijin, MA Li, ZOU Minghui, CHEN Weidan, CHEN Xinxin. Results of surgical treatment for 79 patients with aortic coarctation combined with complex anomalies: A retrospective analysis in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(11): 1466-1471. doi: 10.7507/1007-4848.202011068 Copy

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2.	Quaegebeur JM, Jonas RA, Weinberg AD, et al. Outcomes in seriously ill neonates with coarctation of the aorta. A multiinstitutional study. J Thorac Cardiovasc Surg, 1994, 108(5): 841-851.
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8.	Takayama H, Sekiguchi A, Chikada M, et al. Mortality of pulmonary artery banding in the current era: Recent mortality of PA banding. Ann Thorac Surg, 2002, 74(4): 1219-1223.
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10.	Franklin RC, Spiegelhalter DJ, Anderson RH, et al. Double-inlet ventricle presenting in infancy. Ⅱ. Results of palliative operations. J Thorac Cardiovasc Surg, 1991, 101(5): 917-923.
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12.	张鹤, 李玖军. 先天性心脏病患儿血浆脑钠肽水平与左心功能的关系. 中国当代儿科杂志, 2012, 14(1): 42-44.
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1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol, 2002, 39(12): 1890-1900.
2. Quaegebeur JM, Jonas RA, Weinberg AD, et al. Outcomes in seriously ill neonates with coarctation of the aorta. A multiinstitutional study. J Thorac Cardiovasc Surg, 1994, 108(5): 841-851.
3. 吴雨昊,周悦航,金鑫,等. 86例主动脉缩窄合并心内畸形患婴的一期手术治疗效果. 中华胸心血管外科杂志, 2019, 35(9): 526-529.
4. 葛同开, 陈寄梅, 庄建, 等. 117例主动脉缩窄合并室间隔缺损一期矫治手术的疗效. 中华胸心血管外科杂志, 2015, 31(3): 138-141.
5. 陈欣欣, 张镜芳, 庄建, 等. 经胸骨正中切口一期矫治小儿主动脉缩窄及合并畸形. 中华胸心血管外科杂志, 2006, 22(6): 374-376.
6. 高伟年, 陈欣欣, 夏园生, 等. 主动脉扩大端端吻合术治疗婴幼儿主动脉缩窄的中期随访. 中华小儿外科杂志, 2013, 34(7): 489-492.
7. 刘爱军, 刘承虎, 王执一, 等. 肺动脉环缩术在先天性心脏病分期手术中的应用效果观察. 中西医结合心脑血管病杂志, 2020, 18(13): 2126-2130.
8. Takayama H, Sekiguchi A, Chikada M, et al. Mortality of pulmonary artery banding in the current era: Recent mortality of PA banding. Ann Thorac Surg, 2002, 74(4): 1219-1223.
9. Alsoufi B, Manlhiot C, Ehrlich A, et al. Results of palliation with an initial pulmonary artery band in patients with single ventricle associated with unrestricted pulmonary blood flow. J Thorac Cardiovasc Surg, 2015, 149(1): 213-220.
10. Franklin RC, Spiegelhalter DJ, Anderson RH, et al. Double-inlet ventricle presenting in infancy. Ⅱ. Results of palliative operations. J Thorac Cardiovasc Surg, 1991, 101(5): 917-923.
11. Franklin RC, Spiegelhalter DJ, Rossi Filho RI, et al. Double-inlet ventricle presenting in infancy. Ⅲ. Outcome and potential for definitive repair. J Thorac Cardiovasc Surg, 1991, 101(5): 924-934.
12. 张鹤, 李玖军. 先天性心脏病患儿血浆脑钠肽水平与左心功能的关系. 中国当代儿科杂志, 2012, 14(1): 42-44.
13. 沈君. 婴幼儿先天性心脏病围术期hs-CRP和cTnI监测的临床意义. 中国循证心血管医学杂志, 2013, 5(1): 40-42.
14. 黄继红, 徐卓明, 张明杰, 等. 区域组织氧饱和度和乳酸联合预测先天性心脏病术后早期转归. 中国胸心血管外科临床杂志, 2019, 26(8): 772-776.
15. Pedersen KR, Hjortdal VE, Christensen S, et al. Clinical outcome in children with acute renal failure treated with peritoneal dialysis after surgery for congenital heart disease. Kidney Int Suppl, 2008, (108): S81-S86.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Results of surgical treatment for 79 patients with aortic coarctation combined with complex anomalies: A retrospective analysis in a single center

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