Vol. 22 No. 4 (2018)
SPECIAL THEME: PEDIATRIC CARDIAC SURGERY

Coarctation repair through left thoracotomy in neonates and infants

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  • M. Belyaeva,
  • V. Ilyin,
  • O. Kornouhov,
  • Yu. Kornouhov,
  • O. Kalinina
M. Belyaeva
Filatov Children’s Hospital, Moscow, Russian Federation
V. Ilyin
Filatov Children’s Hospital, Moscow, Russian Federation
O. Kornouhov
Filatov Children’s Hospital, Moscow, Russian Federation
Bio
Yu. Kornouhov
Filatov Children’s Hospital, Moscow, Russian Federation
O. Kalinina
Filatov Children’s Hospital, Moscow, Russian Federation
DOI: https://doi.org/10.21688/1681-3472-2018-4-12-20

Published 2018-12-29

Keywords

  • aortic arch hypoplasia,
  • coarctation of the aorta,
  • congenital heart disease,
  • extended end-to-end anastomosis,
  • left thoracotomy

How to Cite

Belyaeva, M., Ilyin, V., Kornouhov, O., Kornouhov, Y., & Kalinina, O. (2018). Coarctation repair through left thoracotomy in neonates and infants. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 22(4), 12–20. https://doi.org/10.21688/1681-3472-2018-4-12-20

Copyright (c) 2018 Belyaeva M. M., Ilyin V. N., Kornouhov O. Yu., Kornouhov Yu. Yu., Kalinina O. I.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Aim. A growing interest in the use of sternotomy and perfusion for repair of aortic coarctation in neonates and infants has enabled us to retrospectively review our own experience in this practice. Our purpose was to determine the efficacy of coarctation repair with extended end-to-end anastomosis through left thoracotomy focusing on a re-intervention rate and dynamics of transverse aortic arch growth during long-term follow-up.
Methods. One hundred and twenty-four patients under 3 months old who underwent coarctation repair (between 2008 and 2016) were enrolled in this study. In 43 patients (35%), aorta coarctation was combined with ventricular septal defect, 49 patients (39.5%) had transversal aortic arch hypoplasia (Z-score less than –2). All operations were carried out by using extended “end-to-end” anastomosis technique via thoracotomy. In patients with concomitant ventricular septal defect, PA-banding was performed simultaneously. Overall follow-up was 3.6 (0.3–8.0) years.
Results. Early mortality was 1.6%. Late survival rate was 93.5%. Recurrent aortic arch obstruction was revealed in 10 (8%) patients, on the average, in 6.5 (3.5–15) months after coarctation repair. Management of re-stenosis with balloon aortoplasty was effective in all cases and had no complications. A statistically significant growth (p<0.001) of the transverse aortic arch was observed in those patients who had hypoplasia of the arch before surgery.
Conclusion. Repair of coarctation of the aorta by resection and extended “end-to-end” anastomosis via thoracotomy without perfusion has low operative mortality, an excellent survival rate and a reduced rate of balloon re-intervention. Patients with baseline moderate transverse aortic arch hypoplasia demonstrate a growth of the aorta up to normal values in long-term follow-up. Endovascular balloon dilatation of aortic re-coarctation zone during long-term follow-up is an effective and safe procedure.

Received 20 June 2018. Revised 5 September 2018. Accepted 12 September 2018.

Funding: The study did not have sponsorship.

Conflict of interest: Authors declare no conflict of interest.

Author contributions
Conception and study design: V.N. Ilyin
Data collection and analysis: M.M. Belyaeva, O.Yu. Kornoukhov, Yu.Yu. Kornoukhov, O.I. Kalinina
Drafting the article: M.M. Belyaeva
Critical revision of the article: V.N. Ilyin, O.Yu. Kornoukhov
Final approval of the version to be published: M.M. Belyaeva, V.N. Ilyin, O.Yu. Kornoukhov, Yu.Yu. Kornoukhov, O.I. Kalinina

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