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, 莫緒明, 彭衛, 等. 合并主動脈弓發育不良的主動脈縮窄的外科治療研究. 中華小兒外科雜志, 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.	國家衛生健康委員會人才交流服務中心兒科呼吸內鏡診療技術專家組, 中國醫師協會兒科醫師分會內鏡專業委員會, 中國醫師協會內鏡醫師分會兒科呼吸內鏡專業委員會, 等. 中國兒科可彎曲支氣管鏡術指南(2018年版). 中華實用兒科臨床雜志, 2018, 33(13): 983-989.
17.	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.
18.	彭樂, 周曉東, 張青, 等. 體外循環下新生兒主動脈縮窄合并主動脈弓發育不良矯治的策略分析. 中華胸心血管外科雜志, 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.	張海波, 李守軍. 先天性心臟病外科治療中國專家共識(十一): 主動脈縮窄與主動脈弓中斷. 中國胸心血管外科臨床雜志, 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, 莫緒明, 彭衛, 等. 合并主動脈弓發育不良的主動脈縮窄的外科治療研究. 中華小兒外科雜志, 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. 國家衛生健康委員會人才交流服務中心兒科呼吸內鏡診療技術專家組, 中國醫師協會兒科醫師分會內鏡專業委員會, 中國醫師協會內鏡醫師分會兒科呼吸內鏡專業委員會, 等. 中國兒科可彎曲支氣管鏡術指南(2018年版). 中華實用兒科臨床雜志, 2018, 33(13): 983-989.
17. 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.
18. 彭樂, 周曉東, 張青, 等. 體外循環下新生兒主動脈縮窄合并主動脈弓發育不良矯治的策略分析. 中華胸心血管外科雜志, 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. 張海波, 李守軍. 先天性心臟病外科治療中國專家共識(十一): 主動脈縮窄與主動脈弓中斷. 中國胸心血管外科臨床雜志, 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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