Aortic Arch Advancement for Aortic Coarctation and Hypoplastic Aortic Arch in Neonates and Infants

Background The optimal treatment for infants with aortic coarctation and hypoplastic aortic arch is controversial. The goal of this study was to report the short-term and mid-term outcomes of aortic arch advancement (AAA) in infants with hypoplastic aortic arch. Methods All infants who underwent AAA...

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Published inThe Annals of thoracic surgery Vol. 98; no. 2; pp. 625 - 633
Main Authors Mery, Carlos M., MD, MPH, Guzmán-Pruneda, Francisco A., MD, Carberry, Kathleen E., RN, MPH, Watrin, Carmen H., RN, MSN, McChesney, Grant R., BS, Chan, Joyce G., RN, Adachi, Iki, MD, Heinle, Jeffrey S., MD, McKenzie, E. Dean, MD, Fraser, Charles D., MD
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LanguageEnglish
Published Netherlands Elsevier Inc 01.08.2014
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Abstract Background The optimal treatment for infants with aortic coarctation and hypoplastic aortic arch is controversial. The goal of this study was to report the short-term and mid-term outcomes of aortic arch advancement (AAA) in infants with hypoplastic aortic arch. Methods All infants who underwent AAA at our institution from 1995 to 2012 were included. AAA consisted of coarctectomy and end-to-side anastomosis of the descending aorta to the distal ascending aorta/proximal arch through a median sternotomy. The cohort was divided into four groups: (1) isolated AAA (n = 29, 11%), (2) AAA with closure of ventricular septal defect (n = 56, 20%), (3) AAA with other biventricular repairs (n = 115, 42%), and (4) AAA as part of single-ventricle palliation (n = 75, 27%). Results The cohort included 275 patients: 125 (45%) were female, and the median age was 14 days (interquartile range, 7–34 days). Genetic abnormalities were present in 48 patients (17%). Neurologic adverse events occurred in 3 patients (1%), all in group 4. Left bronchial compression was seen in 2 patients (0.7%); only one required intervention. Vocal cord dysfunction was noted in 36 of 95 patients (38%) on routine laryngoscopy. Only 1 patient had clinical residual dysfunction at the last follow-up visit. Perioperative mortality was 3% (n = 8). At a median follow-up time of 6 years, 8 patients (3%) had reinterventions at a median time of 5 months (3–17 months) after repair. Conclusions AAA is a safe, effective, and durable operation with low rates of adverse events and mid-term reintervention. The advantages include native tissue-to-tissue reconstruction and preserved potential for growth. As such, it is the ideal technique for the management of hypoplastic aortic arch in neonates and infants.
AbstractList The optimal treatment for infants with aortic coarctation and hypoplastic aortic arch is controversial. The goal of this study was to report the short-term and mid-term outcomes of aortic arch advancement (AAA) in infants with hypoplastic aortic arch. All infants who underwent AAA at our institution from 1995 to 2012 were included. AAA consisted of coarctectomy and end-to-side anastomosis of the descending aorta to the distal ascending aorta/proximal arch through a median sternotomy. The cohort was divided into four groups: (1) isolated AAA (n=29, 11%), (2) AAA with closure of ventricular septal defect (n=56, 20%), (3) AAA with other biventricular repairs (n=115, 42%), and (4) AAA as part of single-ventricle palliation (n=75, 27%). The cohort included 275 patients: 125 (45%) were female, and the median age was 14 days (interquartile range, 7-34 days). Genetic abnormalities were present in 48 patients (17%). Neurologic adverse events occurred in 3 patients (1%), all in group 4. Left bronchial compression was seen in 2 patients (0.7%); only one required intervention. Vocal cord dysfunction was noted in 36 of 95 patients (38%) on routine laryngoscopy. Only 1 patient had clinical residual dysfunction at the last follow-up visit. Perioperative mortality was 3% (n=8). At a median follow-up time of 6 years, 8 patients (3%) had reinterventions at a median time of 5 months (3-17 months) after repair. AAA is a safe, effective, and durable operation with low rates of adverse events and mid-term reintervention. The advantages include native tissue-to-tissue reconstruction and preserved potential for growth. As such, it is the ideal technique for the management of hypoplastic aortic arch in neonates and infants.
Background The optimal treatment for infants with aortic coarctation and hypoplastic aortic arch is controversial. The goal of this study was to report the short-term and mid-term outcomes of aortic arch advancement (AAA) in infants with hypoplastic aortic arch. Methods All infants who underwent AAA at our institution from 1995 to 2012 were included. AAA consisted of coarctectomy and end-to-side anastomosis of the descending aorta to the distal ascending aorta/proximal arch through a median sternotomy. The cohort was divided into four groups: (1) isolated AAA (n = 29, 11%), (2) AAA with closure of ventricular septal defect (n = 56, 20%), (3) AAA with other biventricular repairs (n = 115, 42%), and (4) AAA as part of single-ventricle palliation (n = 75, 27%). Results The cohort included 275 patients: 125 (45%) were female, and the median age was 14 days (interquartile range, 7–34 days). Genetic abnormalities were present in 48 patients (17%). Neurologic adverse events occurred in 3 patients (1%), all in group 4. Left bronchial compression was seen in 2 patients (0.7%); only one required intervention. Vocal cord dysfunction was noted in 36 of 95 patients (38%) on routine laryngoscopy. Only 1 patient had clinical residual dysfunction at the last follow-up visit. Perioperative mortality was 3% (n = 8). At a median follow-up time of 6 years, 8 patients (3%) had reinterventions at a median time of 5 months (3–17 months) after repair. Conclusions AAA is a safe, effective, and durable operation with low rates of adverse events and mid-term reintervention. The advantages include native tissue-to-tissue reconstruction and preserved potential for growth. As such, it is the ideal technique for the management of hypoplastic aortic arch in neonates and infants.
The optimal treatment for infants with aortic coarctation and hypoplastic aortic arch is controversial. The goal of this study was to report the short-term and mid-term outcomes of aortic arch advancement (AAA) in infants with hypoplastic aortic arch. All infants who underwent AAA at our institution from 1995 to 2012 were included. AAA consisted of coarctectomy and end-to-side anastomosis of the descending aorta to the distal ascending aorta/proximal arch through a median sternotomy. The cohort was divided into four groups: (1) isolated AAA (n = 29, 11%), (2) AAA with closure of ventricular septal defect (n = 56, 20%), (3) AAA with other biventricular repairs (n = 115, 42%), and (4) AAA as part of single-ventricle palliation (n = 75, 27%). The cohort included 275 patients: 125 (45%) were female, and the median age was 14 days (interquartile range, 7–34 days). Genetic abnormalities were present in 48 patients (17%). Neurologic adverse events occurred in 3 patients (1%), all in group 4. Left bronchial compression was seen in 2 patients (0.7%); only one required intervention. Vocal cord dysfunction was noted in 36 of 95 patients (38%) on routine laryngoscopy. Only 1 patient had clinical residual dysfunction at the last follow-up visit. Perioperative mortality was 3% (n = 8). At a median follow-up time of 6 years, 8 patients (3%) had reinterventions at a median time of 5 months (3–17 months) after repair. AAA is a safe, effective, and durable operation with low rates of adverse events and mid-term reintervention. The advantages include native tissue-to-tissue reconstruction and preserved potential for growth. As such, it is the ideal technique for the management of hypoplastic aortic arch in neonates and infants.
BACKGROUNDThe optimal treatment for infants with aortic coarctation and hypoplastic aortic arch is controversial. The goal of this study was to report the short-term and mid-term outcomes of aortic arch advancement (AAA) in infants with hypoplastic aortic arch.METHODSAll infants who underwent AAA at our institution from 1995 to 2012 were included. AAA consisted of coarctectomy and end-to-side anastomosis of the descending aorta to the distal ascending aorta/proximal arch through a median sternotomy. The cohort was divided into four groups: (1) isolated AAA (n=29, 11%), (2) AAA with closure of ventricular septal defect (n=56, 20%), (3) AAA with other biventricular repairs (n=115, 42%), and (4) AAA as part of single-ventricle palliation (n=75, 27%).RESULTSThe cohort included 275 patients: 125 (45%) were female, and the median age was 14 days (interquartile range, 7-34 days). Genetic abnormalities were present in 48 patients (17%). Neurologic adverse events occurred in 3 patients (1%), all in group 4. Left bronchial compression was seen in 2 patients (0.7%); only one required intervention. Vocal cord dysfunction was noted in 36 of 95 patients (38%) on routine laryngoscopy. Only 1 patient had clinical residual dysfunction at the last follow-up visit. Perioperative mortality was 3% (n=8). At a median follow-up time of 6 years, 8 patients (3%) had reinterventions at a median time of 5 months (3-17 months) after repair.CONCLUSIONSAAA is a safe, effective, and durable operation with low rates of adverse events and mid-term reintervention. The advantages include native tissue-to-tissue reconstruction and preserved potential for growth. As such, it is the ideal technique for the management of hypoplastic aortic arch in neonates and infants.
Author Mery, Carlos M., MD, MPH
Carberry, Kathleen E., RN, MPH
Watrin, Carmen H., RN, MSN
Adachi, Iki, MD
Heinle, Jeffrey S., MD
Guzmán-Pruneda, Francisco A., MD
Chan, Joyce G., RN
McChesney, Grant R., BS
McKenzie, E. Dean, MD
Fraser, Charles D., MD
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Snippet Background The optimal treatment for infants with aortic coarctation and hypoplastic aortic arch is controversial. The goal of this study was to report the...
The optimal treatment for infants with aortic coarctation and hypoplastic aortic arch is controversial. The goal of this study was to report the short-term and...
BACKGROUNDThe optimal treatment for infants with aortic coarctation and hypoplastic aortic arch is controversial. The goal of this study was to report the...
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SubjectTerms Abnormalities, Multiple - surgery
Aorta, Thoracic - abnormalities
Aorta, Thoracic - surgery
Aortic Coarctation - complications
Aortic Coarctation - surgery
Cardiac Surgical Procedures - methods
Cardiothoracic Surgery
Female
Humans
Infant
Infant, Newborn
Male
Retrospective Studies
Surgery
Vascular Surgical Procedures - methods
Title Aortic Arch Advancement for Aortic Coarctation and Hypoplastic Aortic Arch in Neonates and Infants
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https://dx.doi.org/10.1016/j.athoracsur.2014.04.051
https://www.ncbi.nlm.nih.gov/pubmed/24928673
https://search.proquest.com/docview/1551327603
Volume 98
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