Coarctation of the Aorta: Midterm Outcomes of Resection With Extended End-to-End Anastomosis

Sunjay Kaushal*, Carl L Backer, Jay N. Patel, Shivani K. Patel, Brandon L. Walker, Thomas J. Weigel, Guy Randolph, David F Wax, Constantine Mavroudis

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

Background: We began using the technique of resection with extended end-to-end anastomosis for infants and children with coarctation of the aorta in 1991. The purpose of this review is to evaluate the midterm outcomes of this technique, specifically determining the incidence of and risk factors for transcatheter or surgical reintervention. Methods: A retrospective analysis of the cardiac surgery database was performed to identify all patients who had a diagnosis of coarctation of the aorta with or without ventricular septal defect and had resection with extended end-to-end anastomosis from 1991 to 2007. Perioperative course and follow-up with physical examination, echocardiogram, and cardiology evaluation were obtained. Results: From 1991 through 2007, 201 patients had repair of coarctation of the aorta with resection with extended end-to-end anastomosis. The median age was 23 days, and the median weight was 4.0 kg. Surgical approach was by left thoracotomy in 157 patients (78%) with a mean cross-clamp time of 18 ± 4 minutes. Median sternotomy approach was used in 44 patients (22%) to repair a hypoplastic transverse aortic arch (n = 16) or because of associated ventricular septal defect (n = 28) with a mean circulatory arrest time of 14 ± 9 minutes. Early mortality occurred in 4 patients (2.0%). Three patients (1.5%) required early arch revision: 2 intraoperatively and 1 on postoperative day 1. Follow-up data were available for 182 patients (91%) with a mean follow-up of 5.0 ± 4.3 years (908 patient-years). Reinterventions (n = 8; 4.0%) included three balloon angioplasties and five reoperations; 75% of the reinterventions occurred in the first postoperative year. Hypoplastic transverse aortic arch was not a risk factor for reintervention (p = 0.36), but was a risk factor for mortality (p = 0.039). Aberrant right subclavian artery was the only risk factor for recoarctation (p = 0.007). Conclusions: Repair of coarctation of the aorta with resection with extended end-to-end anastomosis has a low early mortality, effectively addresses transverse arch hypoplasia, and at midterm follow-up has a low rate of reintervention for recurrent coarctation.

Original languageEnglish (US)
Pages (from-to)1932-1938
Number of pages7
JournalAnnals of Thoracic Surgery
Volume88
Issue number6
DOIs
StatePublished - Dec 1 2009

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Aortic Coarctation
Ventricular Heart Septal Defects
Thoracic Aorta
Mortality
Sternotomy
Balloon Angioplasty
Thoracotomy
Cardiology
Reoperation
Thoracic Surgery
Physical Examination
Databases
Weights and Measures
Incidence

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Kaushal, Sunjay ; Backer, Carl L ; Patel, Jay N. ; Patel, Shivani K. ; Walker, Brandon L. ; Weigel, Thomas J. ; Randolph, Guy ; Wax, David F ; Mavroudis, Constantine. / Coarctation of the Aorta : Midterm Outcomes of Resection With Extended End-to-End Anastomosis. In: Annals of Thoracic Surgery. 2009 ; Vol. 88, No. 6. pp. 1932-1938.
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title = "Coarctation of the Aorta: Midterm Outcomes of Resection With Extended End-to-End Anastomosis",
abstract = "Background: We began using the technique of resection with extended end-to-end anastomosis for infants and children with coarctation of the aorta in 1991. The purpose of this review is to evaluate the midterm outcomes of this technique, specifically determining the incidence of and risk factors for transcatheter or surgical reintervention. Methods: A retrospective analysis of the cardiac surgery database was performed to identify all patients who had a diagnosis of coarctation of the aorta with or without ventricular septal defect and had resection with extended end-to-end anastomosis from 1991 to 2007. Perioperative course and follow-up with physical examination, echocardiogram, and cardiology evaluation were obtained. Results: From 1991 through 2007, 201 patients had repair of coarctation of the aorta with resection with extended end-to-end anastomosis. The median age was 23 days, and the median weight was 4.0 kg. Surgical approach was by left thoracotomy in 157 patients (78{\%}) with a mean cross-clamp time of 18 ± 4 minutes. Median sternotomy approach was used in 44 patients (22{\%}) to repair a hypoplastic transverse aortic arch (n = 16) or because of associated ventricular septal defect (n = 28) with a mean circulatory arrest time of 14 ± 9 minutes. Early mortality occurred in 4 patients (2.0{\%}). Three patients (1.5{\%}) required early arch revision: 2 intraoperatively and 1 on postoperative day 1. Follow-up data were available for 182 patients (91{\%}) with a mean follow-up of 5.0 ± 4.3 years (908 patient-years). Reinterventions (n = 8; 4.0{\%}) included three balloon angioplasties and five reoperations; 75{\%} of the reinterventions occurred in the first postoperative year. Hypoplastic transverse aortic arch was not a risk factor for reintervention (p = 0.36), but was a risk factor for mortality (p = 0.039). Aberrant right subclavian artery was the only risk factor for recoarctation (p = 0.007). Conclusions: Repair of coarctation of the aorta with resection with extended end-to-end anastomosis has a low early mortality, effectively addresses transverse arch hypoplasia, and at midterm follow-up has a low rate of reintervention for recurrent coarctation.",
author = "Sunjay Kaushal and Backer, {Carl L} and Patel, {Jay N.} and Patel, {Shivani K.} and Walker, {Brandon L.} and Weigel, {Thomas J.} and Guy Randolph and Wax, {David F} and Constantine Mavroudis",
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Kaushal, S, Backer, CL, Patel, JN, Patel, SK, Walker, BL, Weigel, TJ, Randolph, G, Wax, DF & Mavroudis, C 2009, 'Coarctation of the Aorta: Midterm Outcomes of Resection With Extended End-to-End Anastomosis', Annals of Thoracic Surgery, vol. 88, no. 6, pp. 1932-1938. https://doi.org/10.1016/j.athoracsur.2009.08.035

Coarctation of the Aorta : Midterm Outcomes of Resection With Extended End-to-End Anastomosis. / Kaushal, Sunjay; Backer, Carl L; Patel, Jay N.; Patel, Shivani K.; Walker, Brandon L.; Weigel, Thomas J.; Randolph, Guy; Wax, David F; Mavroudis, Constantine.

In: Annals of Thoracic Surgery, Vol. 88, No. 6, 01.12.2009, p. 1932-1938.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Coarctation of the Aorta

T2 - Midterm Outcomes of Resection With Extended End-to-End Anastomosis

AU - Kaushal, Sunjay

AU - Backer, Carl L

AU - Patel, Jay N.

AU - Patel, Shivani K.

AU - Walker, Brandon L.

AU - Weigel, Thomas J.

AU - Randolph, Guy

AU - Wax, David F

AU - Mavroudis, Constantine

PY - 2009/12/1

Y1 - 2009/12/1

N2 - Background: We began using the technique of resection with extended end-to-end anastomosis for infants and children with coarctation of the aorta in 1991. The purpose of this review is to evaluate the midterm outcomes of this technique, specifically determining the incidence of and risk factors for transcatheter or surgical reintervention. Methods: A retrospective analysis of the cardiac surgery database was performed to identify all patients who had a diagnosis of coarctation of the aorta with or without ventricular septal defect and had resection with extended end-to-end anastomosis from 1991 to 2007. Perioperative course and follow-up with physical examination, echocardiogram, and cardiology evaluation were obtained. Results: From 1991 through 2007, 201 patients had repair of coarctation of the aorta with resection with extended end-to-end anastomosis. The median age was 23 days, and the median weight was 4.0 kg. Surgical approach was by left thoracotomy in 157 patients (78%) with a mean cross-clamp time of 18 ± 4 minutes. Median sternotomy approach was used in 44 patients (22%) to repair a hypoplastic transverse aortic arch (n = 16) or because of associated ventricular septal defect (n = 28) with a mean circulatory arrest time of 14 ± 9 minutes. Early mortality occurred in 4 patients (2.0%). Three patients (1.5%) required early arch revision: 2 intraoperatively and 1 on postoperative day 1. Follow-up data were available for 182 patients (91%) with a mean follow-up of 5.0 ± 4.3 years (908 patient-years). Reinterventions (n = 8; 4.0%) included three balloon angioplasties and five reoperations; 75% of the reinterventions occurred in the first postoperative year. Hypoplastic transverse aortic arch was not a risk factor for reintervention (p = 0.36), but was a risk factor for mortality (p = 0.039). Aberrant right subclavian artery was the only risk factor for recoarctation (p = 0.007). Conclusions: Repair of coarctation of the aorta with resection with extended end-to-end anastomosis has a low early mortality, effectively addresses transverse arch hypoplasia, and at midterm follow-up has a low rate of reintervention for recurrent coarctation.

AB - Background: We began using the technique of resection with extended end-to-end anastomosis for infants and children with coarctation of the aorta in 1991. The purpose of this review is to evaluate the midterm outcomes of this technique, specifically determining the incidence of and risk factors for transcatheter or surgical reintervention. Methods: A retrospective analysis of the cardiac surgery database was performed to identify all patients who had a diagnosis of coarctation of the aorta with or without ventricular septal defect and had resection with extended end-to-end anastomosis from 1991 to 2007. Perioperative course and follow-up with physical examination, echocardiogram, and cardiology evaluation were obtained. Results: From 1991 through 2007, 201 patients had repair of coarctation of the aorta with resection with extended end-to-end anastomosis. The median age was 23 days, and the median weight was 4.0 kg. Surgical approach was by left thoracotomy in 157 patients (78%) with a mean cross-clamp time of 18 ± 4 minutes. Median sternotomy approach was used in 44 patients (22%) to repair a hypoplastic transverse aortic arch (n = 16) or because of associated ventricular septal defect (n = 28) with a mean circulatory arrest time of 14 ± 9 minutes. Early mortality occurred in 4 patients (2.0%). Three patients (1.5%) required early arch revision: 2 intraoperatively and 1 on postoperative day 1. Follow-up data were available for 182 patients (91%) with a mean follow-up of 5.0 ± 4.3 years (908 patient-years). Reinterventions (n = 8; 4.0%) included three balloon angioplasties and five reoperations; 75% of the reinterventions occurred in the first postoperative year. Hypoplastic transverse aortic arch was not a risk factor for reintervention (p = 0.36), but was a risk factor for mortality (p = 0.039). Aberrant right subclavian artery was the only risk factor for recoarctation (p = 0.007). Conclusions: Repair of coarctation of the aorta with resection with extended end-to-end anastomosis has a low early mortality, effectively addresses transverse arch hypoplasia, and at midterm follow-up has a low rate of reintervention for recurrent coarctation.

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