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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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.	張鶴, 李玖軍. 先天性心臟病患兒血漿腦鈉肽水平與左心功能的關系. 中國當代兒科雜志, 2012, 14(1): 42-44.
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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.

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. 吳雨昊,周悅航,金鑫,等. 86例主動脈縮窄合并心內畸形患嬰的一期手術治療效果. 中華胸心血管外科雜志, 2019, 35(9): 526-529.
4. 葛同開, 陳寄梅, 莊建, 等. 117例主動脈縮窄合并室間隔缺損一期矯治手術的療效. 中華胸心血管外科雜志, 2015, 31(3): 138-141.
5. 陳欣欣, 張鏡芳, 莊建, 等. 經胸骨正中切口一期矯治小兒主動脈縮窄及合并畸形. 中華胸心血管外科雜志, 2006, 22(6): 374-376.
6. 高偉年, 陳欣欣, 夏園生, 等. 主動脈擴大端端吻合術治療嬰幼兒主動脈縮窄的中期隨訪. 中華小兒外科雜志, 2013, 34(7): 489-492.
7. 劉愛軍, 劉承虎, 王執一, 等. 肺動脈環縮術在先天性心臟病分期手術中的應用效果觀察. 中西醫結合心腦血管病雜志, 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. 張鶴, 李玖軍. 先天性心臟病患兒血漿腦鈉肽水平與左心功能的關系. 中國當代兒科雜志, 2012, 14(1): 42-44.
13. 沈君. 嬰幼兒先天性心臟病圍術期hs-CRP和cTnI監測的臨床意義. 中國循證心血管醫學雜志, 2013, 5(1): 40-42.
14. 黃繼紅, 徐卓明, 張明杰, 等. 區域組織氧飽和度和乳酸聯合預測先天性心臟病術后早期轉歸. 中國胸心血管外科臨床雜志, 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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