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Repair of isolated aortic coarctation over two decades: impact of surgical approach and associated arch hypoplasia.

Abstract

OBJECTIVES
A variety of surgical approaches and techniques are used for isolated coarctation repair. We have retrospectively reviewed our results of isolated repair of coarctation over the last 20 years, to establish whether the approach affects clinical outcome and the need for re-intervention.
METHODS
Two hundred and eighty-eight patients who underwent isolated repair for coarctation of the aorta at Birmingham Children's Hospital between 1991 and 2010 were enrolled in this study. Chart review and the Departmental database were used to determine demographics, operative details and complications.
RESULTS
The majority of patients (n = 237, 82%) underwent surgical repair via thoracotomy techniques, whereas median sternotomy was used in patients where there was associated arch hypoplasia (n = 51, 18%). For all 288 patients, median age at operation was 24 days (range 0-14 years). Between 1991 and 2000, ten patients (6%) underwent repair through midline sternotomy, increasing to 41 patients (36%) between 2001 and 2010. Overall early mortality was 1% and late mortality was 3%. There was a statistically higher re-intervention rate (16%) in the decade 1991-2000, compared to 5% in the period 2001-10 (P = 0.02). In patients with hypoplastic arch, the midline approach has a lower re-intervention rate than thoracotomy (P < 0.001).
CONCLUSIONS
In our institution, there has been a trend in recent years towards increased use of median sternotomy to repair the aortic arch, which has been associated with a reduced rate of re-intervention. The midline sternotomy approach for coarctation with arch hypoplasia significantly reduces the risk of re-coarctation.

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  • Publisher Full Text

    • Authors

    Sakurai T, Stickley J, Stümper O, Khan N, Jones TJ, Barron DJ, Brawn WJ

    Institution

    Department of Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK.

    Source

    Interactive cardiovascular and thoracic surgery 15:5 2012 Nov pg 865-70

    MeSH

    Adolescent
    Aorta, Thoracic
    Aortic Coarctation
    Cardiac Surgical Procedures
    Child
    Child, Preschool
    Disease-Free Survival
    England
    Female
    Hospital Mortality
    Humans
    Infant
    Infant, Newborn
    Kaplan-Meier Estimate
    Male
    Postoperative Complications
    Reoperation
    Retrospective Studies
    Risk Factors
    Sternotomy
    Thoracotomy
    Time Factors
    Treatment Outcome
    Vascular Surgical Procedures

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22833510