Outcomes of Repair of Coarctation of Aorta with Hypoplastic Arch Using Extended End-to-Side Anastomosis Technique

Abstract

Introduction: The optimal surgical repair technique for coarctation associated with aortic arch hypoplasia (CoA/AAH) in neonates and infants is controversial. This study evaluates our current strategy utilizing extended end-to-side anastomosis (EESA) under selective cerebral and myocardial perfusion (SCMP) in treating this group of patients. Methods: Through a retrospective review, we analyzed the outcome of 87 infants who underwent surgical repair of CoA/AAH from January 2004 to December 2015.Patients with functional single ventricle were excluded. Results: There were no early mortalities and 4 patients (4.6%) experienced early complications. Eighty-five patients (97.7%) were followed-up during a mean duration of 6.1± 3.53 years. There were 2 late mortalities (2.3%) and 3 re-intervention (3.5%) of the aortic arch. Ten-year overall survival and freedom from re-intervention for the entire cohort was 97.7% and 96.3%, respectively. At last follow-up, 4 patients (4.5%) showed a peak velocity greater than 2.5m/s across the repair site.7patients (8.2%) were hypertensive. Among 44 patients (50.6%) with post-operative CT data, 7 patients (15.9%) showed gothic shaped arches. In the present study, we could not correlate arch geometry with increased blood pressure. Conclusions: Our strategy with EESA under SCMP is safe and effective for repairing CoA/AAH in neonates and infants. Concomitant repair of associated cardiac anomalies can be done without added risk. Surgical results are excellent with low rates of mortality, re-intervention, and late hypertension.