Long-Term Outcomes of Coarctation Repair Through Left Thoracotomy

Melanie R.F. Gropler, Bradley Scott Marino, Michael Richard Carr, William W. Russell, Hongjie Gu, Osama Mohyeldin Eltayeb, Michael C Monge, Carl L Backer*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Optimal surgical approach for repair of coarctation of the aorta (CoA) remains controversial. This study aimed to evaluate reintervention rates and its predictors by using a strategy of resection with extended end-to-end anastomosis (REEEA) through left thoracotomy. Methods: A retrospective analysis was performed for all patients who underwent isolated CoA repair or simultaneous repair of CoA and ventricular septal defect repair by REEEA between January 2000 and December 2015 at Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Patients with complex congenital heart disease were excluded. Transverse arch hypoplasia was defined as echocardiographic z-score lower than −2 or by documentation in medical or operative reports. Reintervention was defined as the need for balloon angioplasty or reoperation. Hypertension was defined as antihypertensive medication use or blood pressure greater than or equal to the 95th percentile. Results: A total of 251 patients with median age at repair of 14.6 days met inclusion criteria. Repair was by left thoracotomy in 226 (90%). Follow-up data were available for 186 of 251 patients, with median follow-up time of 5.4 years (range, 0.2 to 15.3 years); 169 (91%) of these patients underwent thoracotomy. There were no early deaths or early reoperations. A proximal transverse arch z-score lower than −4.1 or a distal transverse arch z-score of less than −2.8 was predictive of repair through sternotomy. Only 4 (2%) patients required reintervention (2 patients had balloon angioplasties, 2 had reoperations). Transverse arch hypoplasia was a risk factor for reintervention (p = 0.048), but surgical approach was not (p = 0.35). Late hypertension was identified in only 33 of 186 (18%) patients. Conclusions: Repair of CoA, even with associated transverse arch hypoplasia, by REEEA through left thoracotomy has a low mortality, low reintervention rate, and low incidence of late hypertension.

Original languageEnglish (US)
Pages (from-to)157-164
Number of pages8
JournalAnnals of Thoracic Surgery
Volume107
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Thoracotomy
Aortic Coarctation
Reoperation
Balloon Angioplasty
Hypertension
Sternotomy
Ventricular Heart Septal Defects
Documentation
Antihypertensive Agents
Heart Diseases
Blood Pressure
Mortality
Incidence

ASJC Scopus subject areas

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

Cite this

@article{baef2beda4194c9e93110f04fa9b922b,
title = "Long-Term Outcomes of Coarctation Repair Through Left Thoracotomy",
abstract = "Background: Optimal surgical approach for repair of coarctation of the aorta (CoA) remains controversial. This study aimed to evaluate reintervention rates and its predictors by using a strategy of resection with extended end-to-end anastomosis (REEEA) through left thoracotomy. Methods: A retrospective analysis was performed for all patients who underwent isolated CoA repair or simultaneous repair of CoA and ventricular septal defect repair by REEEA between January 2000 and December 2015 at Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Patients with complex congenital heart disease were excluded. Transverse arch hypoplasia was defined as echocardiographic z-score lower than −2 or by documentation in medical or operative reports. Reintervention was defined as the need for balloon angioplasty or reoperation. Hypertension was defined as antihypertensive medication use or blood pressure greater than or equal to the 95th percentile. Results: A total of 251 patients with median age at repair of 14.6 days met inclusion criteria. Repair was by left thoracotomy in 226 (90{\%}). Follow-up data were available for 186 of 251 patients, with median follow-up time of 5.4 years (range, 0.2 to 15.3 years); 169 (91{\%}) of these patients underwent thoracotomy. There were no early deaths or early reoperations. A proximal transverse arch z-score lower than −4.1 or a distal transverse arch z-score of less than −2.8 was predictive of repair through sternotomy. Only 4 (2{\%}) patients required reintervention (2 patients had balloon angioplasties, 2 had reoperations). Transverse arch hypoplasia was a risk factor for reintervention (p = 0.048), but surgical approach was not (p = 0.35). Late hypertension was identified in only 33 of 186 (18{\%}) patients. Conclusions: Repair of CoA, even with associated transverse arch hypoplasia, by REEEA through left thoracotomy has a low mortality, low reintervention rate, and low incidence of late hypertension.",
author = "Gropler, {Melanie R.F.} and Marino, {Bradley Scott} and Carr, {Michael Richard} and Russell, {William W.} and Hongjie Gu and Eltayeb, {Osama Mohyeldin} and Monge, {Michael C} and Backer, {Carl L}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.athoracsur.2018.07.027",
language = "English (US)",
volume = "107",
pages = "157--164",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "1",

}

Long-Term Outcomes of Coarctation Repair Through Left Thoracotomy. / Gropler, Melanie R.F.; Marino, Bradley Scott; Carr, Michael Richard; Russell, William W.; Gu, Hongjie; Eltayeb, Osama Mohyeldin; Monge, Michael C; Backer, Carl L.

In: Annals of Thoracic Surgery, Vol. 107, No. 1, 01.01.2019, p. 157-164.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-Term Outcomes of Coarctation Repair Through Left Thoracotomy

AU - Gropler, Melanie R.F.

AU - Marino, Bradley Scott

AU - Carr, Michael Richard

AU - Russell, William W.

AU - Gu, Hongjie

AU - Eltayeb, Osama Mohyeldin

AU - Monge, Michael C

AU - Backer, Carl L

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Optimal surgical approach for repair of coarctation of the aorta (CoA) remains controversial. This study aimed to evaluate reintervention rates and its predictors by using a strategy of resection with extended end-to-end anastomosis (REEEA) through left thoracotomy. Methods: A retrospective analysis was performed for all patients who underwent isolated CoA repair or simultaneous repair of CoA and ventricular septal defect repair by REEEA between January 2000 and December 2015 at Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Patients with complex congenital heart disease were excluded. Transverse arch hypoplasia was defined as echocardiographic z-score lower than −2 or by documentation in medical or operative reports. Reintervention was defined as the need for balloon angioplasty or reoperation. Hypertension was defined as antihypertensive medication use or blood pressure greater than or equal to the 95th percentile. Results: A total of 251 patients with median age at repair of 14.6 days met inclusion criteria. Repair was by left thoracotomy in 226 (90%). Follow-up data were available for 186 of 251 patients, with median follow-up time of 5.4 years (range, 0.2 to 15.3 years); 169 (91%) of these patients underwent thoracotomy. There were no early deaths or early reoperations. A proximal transverse arch z-score lower than −4.1 or a distal transverse arch z-score of less than −2.8 was predictive of repair through sternotomy. Only 4 (2%) patients required reintervention (2 patients had balloon angioplasties, 2 had reoperations). Transverse arch hypoplasia was a risk factor for reintervention (p = 0.048), but surgical approach was not (p = 0.35). Late hypertension was identified in only 33 of 186 (18%) patients. Conclusions: Repair of CoA, even with associated transverse arch hypoplasia, by REEEA through left thoracotomy has a low mortality, low reintervention rate, and low incidence of late hypertension.

AB - Background: Optimal surgical approach for repair of coarctation of the aorta (CoA) remains controversial. This study aimed to evaluate reintervention rates and its predictors by using a strategy of resection with extended end-to-end anastomosis (REEEA) through left thoracotomy. Methods: A retrospective analysis was performed for all patients who underwent isolated CoA repair or simultaneous repair of CoA and ventricular septal defect repair by REEEA between January 2000 and December 2015 at Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Patients with complex congenital heart disease were excluded. Transverse arch hypoplasia was defined as echocardiographic z-score lower than −2 or by documentation in medical or operative reports. Reintervention was defined as the need for balloon angioplasty or reoperation. Hypertension was defined as antihypertensive medication use or blood pressure greater than or equal to the 95th percentile. Results: A total of 251 patients with median age at repair of 14.6 days met inclusion criteria. Repair was by left thoracotomy in 226 (90%). Follow-up data were available for 186 of 251 patients, with median follow-up time of 5.4 years (range, 0.2 to 15.3 years); 169 (91%) of these patients underwent thoracotomy. There were no early deaths or early reoperations. A proximal transverse arch z-score lower than −4.1 or a distal transverse arch z-score of less than −2.8 was predictive of repair through sternotomy. Only 4 (2%) patients required reintervention (2 patients had balloon angioplasties, 2 had reoperations). Transverse arch hypoplasia was a risk factor for reintervention (p = 0.048), but surgical approach was not (p = 0.35). Late hypertension was identified in only 33 of 186 (18%) patients. Conclusions: Repair of CoA, even with associated transverse arch hypoplasia, by REEEA through left thoracotomy has a low mortality, low reintervention rate, and low incidence of late hypertension.

UR - http://www.scopus.com/inward/record.url?scp=85056876798&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056876798&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2018.07.027

DO - 10.1016/j.athoracsur.2018.07.027

M3 - Article

VL - 107

SP - 157

EP - 164

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 1

ER -