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A single centre experience with an evolving approach for the repair of coarctation of the aorta

Published online by Cambridge University Press:  12 July 2019

Kelly Costopoulos ,
Joseph Philip ,
Dalia Lopez-Colon ,
Giridhar Kaliki ,
Arun Chandran  and
Mark Bleiweis
Kelly Costopoulos
Affiliation:
Congenital Heart Center, UF Health Shands Children’s Hospital, University of Florida, Gainesville, FL, USA
Joseph Philip
Affiliation:
Congenital Heart Center, UF Health Shands Children’s Hospital, University of Florida, Gainesville, FL, USA
Dalia Lopez-Colon
Affiliation:
Congenital Heart Center, UF Health Shands Children’s Hospital, University of Florida, Gainesville, FL, USA
Giridhar Kaliki
Affiliation:
Congenital Heart Center, UF Health Shands Children’s Hospital, University of Florida, Gainesville, FL, USA
Arun Chandran
Affiliation:
Congenital Heart Center, UF Health Shands Children’s Hospital, University of Florida, Gainesville, FL, USA
Mark Bleiweis*
Affiliation:
Congenital Heart Center, UF Health Shands Children’s Hospital, University of Florida, Gainesville, FL, USA
*
Author for correspondence: Mark S. Bleiweis, MD, Congenital Heart Center, University of Florida, 1600 SW Archer road, PO Box 100297 UFHSC, Gainesville, FL 32610, USA. Tel: (352) 273-7770; Fax: (352) 273-273-5927; E-mail: bleiweis@ufl.edu
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Abstract

Background:

Isolated coarctation of the aorta can be repaired by either lateral thoracotomy or sternotomy approach with end-to-end anastomosis. Most commonly, neonates with coarctation of the aorta also have hypoplasia of the arch, requiring median sternotomy and extended end-to-side anastomosis with arch augmentation. The aim of this study was to describe our experience as the institution adopted the median sternotomy approach for repair, by reviewing complications, mortality, and reintervention.

Methods:

Retrospective chart review of 66 patients aged 0–1 year who had arch repair performed by a single surgeon over an 8-year period was performed. Median age at surgery was 22 days (4–232) and median weight was 3.08 kg (1.25–8.0). Forty-one (62%) patients underwent median sternotomy.

Results:

There was 1 death from a noncardiac cause. Eighteen per cent of our patients were ≤2.5 kg. Vocal cord paresis occurred in 16% of patients under 2.5 kg and 9.5% of patients 2.5 kg or above at the time of surgery. Hypertension at 6-month follow-up was greater in patients under 2.5 kg (44%) than patients 2.5 kg or above (15%). Total surgical reintervention rate was 6%. For patients above 2.5 kg, the surgical reintervention rate was 5.4% and for patients below 2.5 kg, the surgical reintervention rate was 8.3%.

Conclusion:

We concluded that for neonates with coarctation of the aorta and hypoplastic arch, median sternotomy is a safe surgical approach with low morbidity and mortality with the possible advantage of reduced surgical re-intervention and mortality in the population below 2.5 kg.

Keywords

Coarctation of the aortasternotomy
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 7 , July 2019 , pp. 885 - 887
Copyright
© Cambridge University Press 2019 

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