Surgical management of neonatal coarctation of the aorta with aortic arch hypoplasia: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

REN Qiushi ^1,2 , HUI Chengyi ² , WEN Shusheng ² , CEN Jianzheng ² , LIU Xiaobing ² , HUANG Meiping ³ , QIU Hailong ² , JI Erchao ^1,2 , CHEN Tianyu ² , YU Juemin ^1,2 ,  ZHUANG Jian ^1,2

1. School of Medicine, South China University of Technology, Guangzhou, 510006, P. R. China;
2. Department of Cardiac Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, 510080, P. R. China;
3. Department of Catheterization Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, 510080, P. R. China;

Corresponding author：

ZHUANG Jian, Email: zhuangjian5413@163.com

Keywords：

Coarctation of the aorta; aortic arch hypoplasia; congenital heart diseases; neonate; surgical treatment

DOI：

10.7507/1007-4848.202206036

Video：

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Objective To summarize the surgical treatment experience in neonates with coarctation of the aorta (CoA) and aortic arch hypoplasia (AAH). Methods The neonates with CoA and AAH who underwent surgical treatment in the Department of Pediatric Cardiac Surgery of Guangdong Provincial People's Hospital from 2013 to 2020 were retrospectively enrolled. The postoperative complications, long-term survival rate, and freedom from aortic reobstruction were analyzed. Patients undergoing extended end-to-end anastomosis were allocated into an extended end-to-end group, those undergoing extended end-to-side anastomosis into an extended end-to-side group, and those undergoing pulmonary autograft patch aortoplasty into a patch aortoplasty group.Results Finally 44 patients were enrolled, including 37 males and 7 females, aged 5.00-30.00 (19.34±7.61) days and weighted 2.00-4.50 (3.30±0.60) kg. There were 19 patients of extended end-to-end anastomosis, 19 patients of extended end-to-side anastomosis, and 6 patients of pulmonary autograft patch aortoplasty. The mean values of the Z scores of the proximal, distal, and isthmus of the aortic arch were –2.91±1.52, –3.40±1.30, and –4.04±1.98, respectively. The mean follow-up time was 45.6±3.7 months. There were 2 early deaths and no late deaths. Aortic reobstruction occurred in 8 patients, and 3 patients underwent reoperation intervention. The 5-year rate of freedom from reobstruction was 78.8%. The Cox multivariable regression analysis showed that the related factors for postoperative reobstruction were the Z score of the preoperative proximal aortic arch (HR=0.152, 95%CI 0.038-0.601, P=0.007) and the postoperative left main bronchus compression (HR=15.261, 95%CI 1.104-210.978, P=0.042). Conclusion Three surgical procedures for neonates with CoA and AAH are safe and effective, but the aortic reobstruction rate in long term is not low. The smaller Z score of the preoperative proximal aortic arch and the postoperative left main bronchus compression are risk factors for long-term aortic reobstruction.

Citation： REN Qiushi, HUI Chengyi, WEN Shusheng, CEN Jianzheng, LIU Xiaobing, HUANG Meiping, QIU Hailong, JI Erchao, CHEN Tianyu, YU Juemin, ZHUANG Jian. Surgical management of neonatal coarctation of the aorta with aortic arch hypoplasia: A retrospective study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(6): 890-896. doi: 10.7507/1007-4848.202206036 Copy

1.	Früh S, Knirsch W, Dodge-Khatami A, et al. Comparison of surgical and interventional therapy of native and recurrent aortic coarctation regarding different age groups during childhood. Eur J Cardiothorac Surg, 2011, 39(6): 898-904.
2.	IJsselhof R, Liu H, Pigula F, et al. Rates of interventions in isolated coarctation repair in neonates versus infants: Does age matter? Ann Thorac Surg, 2019, 107(1): 180-186.
3.	Ylinen MK, Tyni VE, Pihkala JI, et al. Procedural risk factors, incidence and timing of reintervention after treatment for native coarctation of the aorta in children: A population-based study. Eur J Cardiothorac Surg, 2019, 55(3): 564-571.
4.	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.
5.	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.
6.	Lehnert A, Villemain O, Gaudin R, et al. Risk factors of mortality and recoarctation after coarctation repair in infancy. Interact Cardiovasc Thorac Surg, 2019, 29(3): 469-475.
7.	Turek JW, Conway BD, Cavanaugh NB, et al. Bovine arch anatomy influences recoarctation rates in the era of the extended end-to-end anastomosis. J Thorac Cardiovasc Surg, 2018, 155(3): 1178-1183.
8.	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.
9.	Adamson G, Karamlou T, Moore P, et al. Coarctation index predicts recurrent aortic arch obstruction following surgical repair of coarctation of the aorta in infants. Pediatr Cardiol, 2017, 38(6): 1241-1246.
10.	胡亮, 莫绪明, 彭卫, 等. 合并主动脉弓发育不良的主动脉缩窄的外科治疗研究. 中华小儿外科杂志, 2018, 39(8): 564-568.
11.	Agarwal PP, Liu PS, Hagan P, et al. Proximal thoracic aortic diameters: Transesophageal-echocardiography- versus computed-tomography-derived measurements. Clin Imaging, 2016, 40(2): 191-199.
12.	Cantinotti M, Giordano R, Scalese M, et al. Nomograms for two-dimensional echocardiography derived valvular and arterial dimensions in Caucasian children. J Cardiol, 2017, 69(1): 208-215.
13.	Hasegawa S, Matsushima S, Matsuhisa H, et al. Selective lesser curvature augmentation with geometric study for repair of aortic arch obstruction. Ann Thorac Surg, 2021, 112(5): 1523-1531.
14.	Ou P, Mousseaux E, Celermajer DS, et al. Aortic arch shape deformation after coarctation surgery: Effect on blood pressure response. J Thorac Cardiovasc Surg, 2006, 132(5): 1105-1111.
15.	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.
16.	国家卫生健康委员会人才交流服务中心儿科呼吸内镜诊疗技术专家组, 中国医师协会儿科医师分会内镜专业委员会, 中国医师协会内镜医师分会儿科呼吸内镜专业委员会, 等. 中国儿科可弯曲支气管镜术指南(2018年版). 中华实用儿科临床杂志, 2018, 33(13): 983-989.
17.	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.
18.	彭乐, 周晓东, 张青, 等. 体外循环下新生儿主动脉缩窄合并主动脉弓发育不良矫治的策略分析. 中华胸心血管外科杂志, 2018, 34(7): 406-408.
19.	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.
20.	Weismann CG, Grell BS, Odermarsky M, et al. Echocardiographic predictors of recoarctation after surgical repair: A Swedish national study. Ann Thorac Surg, 2021, 111(4): 1380-1386.
21.	张海波, 李守军. 先天性心脏病外科治疗中国专家共识(十一): 主动脉缩窄与主动脉弓中断. 中国胸心血管外科临床杂志, 2020, 27(11): 1255-1261.

1. Früh S, Knirsch W, Dodge-Khatami A, et al. Comparison of surgical and interventional therapy of native and recurrent aortic coarctation regarding different age groups during childhood. Eur J Cardiothorac Surg, 2011, 39(6): 898-904.
2. IJsselhof R, Liu H, Pigula F, et al. Rates of interventions in isolated coarctation repair in neonates versus infants: Does age matter? Ann Thorac Surg, 2019, 107(1): 180-186.
3. Ylinen MK, Tyni VE, Pihkala JI, et al. Procedural risk factors, incidence and timing of reintervention after treatment for native coarctation of the aorta in children: A population-based study. Eur J Cardiothorac Surg, 2019, 55(3): 564-571.
4. 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.
5. 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.
6. Lehnert A, Villemain O, Gaudin R, et al. Risk factors of mortality and recoarctation after coarctation repair in infancy. Interact Cardiovasc Thorac Surg, 2019, 29(3): 469-475.
7. Turek JW, Conway BD, Cavanaugh NB, et al. Bovine arch anatomy influences recoarctation rates in the era of the extended end-to-end anastomosis. J Thorac Cardiovasc Surg, 2018, 155(3): 1178-1183.
8. 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.
9. Adamson G, Karamlou T, Moore P, et al. Coarctation index predicts recurrent aortic arch obstruction following surgical repair of coarctation of the aorta in infants. Pediatr Cardiol, 2017, 38(6): 1241-1246.
10. 胡亮, 莫绪明, 彭卫, 等. 合并主动脉弓发育不良的主动脉缩窄的外科治疗研究. 中华小儿外科杂志, 2018, 39(8): 564-568.
11. Agarwal PP, Liu PS, Hagan P, et al. Proximal thoracic aortic diameters: Transesophageal-echocardiography- versus computed-tomography-derived measurements. Clin Imaging, 2016, 40(2): 191-199.
12. Cantinotti M, Giordano R, Scalese M, et al. Nomograms for two-dimensional echocardiography derived valvular and arterial dimensions in Caucasian children. J Cardiol, 2017, 69(1): 208-215.
13. Hasegawa S, Matsushima S, Matsuhisa H, et al. Selective lesser curvature augmentation with geometric study for repair of aortic arch obstruction. Ann Thorac Surg, 2021, 112(5): 1523-1531.
14. Ou P, Mousseaux E, Celermajer DS, et al. Aortic arch shape deformation after coarctation surgery: Effect on blood pressure response. J Thorac Cardiovasc Surg, 2006, 132(5): 1105-1111.
15. 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.
16. 国家卫生健康委员会人才交流服务中心儿科呼吸内镜诊疗技术专家组, 中国医师协会儿科医师分会内镜专业委员会, 中国医师协会内镜医师分会儿科呼吸内镜专业委员会, 等. 中国儿科可弯曲支气管镜术指南(2018年版). 中华实用儿科临床杂志, 2018, 33(13): 983-989.
17. 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.
18. 彭乐, 周晓东, 张青, 等. 体外循环下新生儿主动脉缩窄合并主动脉弓发育不良矫治的策略分析. 中华胸心血管外科杂志, 2018, 34(7): 406-408.
19. 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.
20. Weismann CG, Grell BS, Odermarsky M, et al. Echocardiographic predictors of recoarctation after surgical repair: A Swedish national study. Ann Thorac Surg, 2021, 111(4): 1380-1386.
21. 张海波, 李守军. 先天性心脏病外科治疗中国专家共识(十一): 主动脉缩窄与主动脉弓中断. 中国胸心血管外科临床杂志, 2020, 27(11): 1255-1261.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical management of neonatal coarctation of the aorta with aortic arch hypoplasia: A retrospective study in a single center

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