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Contemporary outcomes of aortic arch hypoplasia and coarctation repair in a tertiary paediatric cardiac surgery centre

Part of: Surgery

Published online by Cambridge University Press:  15 September 2021

Amr Ashry ,
Amer Harky Open the ORCID record for Amer Harky [Opens in a new window] ,
Abdulla Tarmahomed ,
Christopher Ugwu ,
Heba M. Mohammed ,
Ramesh Kutty ,
Attilio Lotto ,
Rafael Guerrero  and
Ramana Dhannapuneni
Amr Ashry*
Affiliation:
Department of Paediatric Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK Department of Cardiothoracic Surgery, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
Amer Harky
Affiliation:
Department of Paediatric Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
Abdulla Tarmahomed
Affiliation:
Department of Paediatric Cardiology, Alder Hey Children Hospital, Liverpool, UK
Christopher Ugwu
Affiliation:
Department of Paediatric Cardiology, Alder Hey Children Hospital, Liverpool, UK
Heba M. Mohammed
Affiliation:
Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
Ramesh Kutty
Affiliation:
Department of Paediatric Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK
Attilio Lotto
Affiliation:
Department of Paediatric Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK Faculty of Health, Liverpool John Moores University, Liverpool, UK
Rafael Guerrero
Affiliation:
Department of Paediatric Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK
Ramana Dhannapuneni
Affiliation:
Department of Paediatric Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK
*
Author for correspondence: A. Ashry, MD, Department of Paediatric Cardiac Surgery, Alder Hey Children Hospital, E Prescot Road, Liverpool, L14 5AB, UK. Tel: +201005002884; Fax: 0044151 252 5643. E-mail: [email protected]
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Abstract

Objectives:

There are several studies reporting the outcomes of hypoplastic aortic arch and aortic coarctation repair with combination of techniques. However, only few studies reported of aortic arch and coarctation repair using a homograft patch through sternotomy and circulatory arrest with antegrade cerebral perfusion. We report our experience and outcomes of this cohort of neonates and infants.

Methods:

We performed retrospective data collection for all neonates and infants who underwent aortic arch reconstruction between 2015 and 2020 at our institute. Data are presented as median and inter-quartile range (IQR).

Results:

The cohort included 76 patients: 49 were males (64.5%). Median age at operation was 16 days (IQR 9–43.25 days). Median weight was 3.5 kg (IQR 3.10–4 kg). There was no 30 days mortality. Three patients died in hospital after 30 days (3.95%), neurological adverse events occurred in only one patient (1.32%) and recurrent laryngeal nerve injury was noted in four patients (5.26%). Only three patients required the support of extracorporeal membrane oxygenation (ECMO) with a median ECMO run of 4 days. Median follow-up was 35 months (IQR 18.9–46.4 months); 5 years survival was 93.42% (n = 71). The rate of re-intervention on the aortic arch was 9.21% (n = 7).

Conclusion:

Our experience shows excellent outcomes in repairing aortic arch hypoplasia with homograft patch under moderate to deep hypothermia with low in-hospital and 5 years mortality rates.

Keywords

Aortic arch hypoplasiacoarctationhomograftselective cerebral perfusion
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 7 , July 2022 , pp. 1098 - 1103
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Rakhra, SS, Lee, M, Iyengar, AJ, et al. Poor outcomes after surgery for coarctation repair with hypoplastic arch warrants more extensive initial surgery and close long-term follow-up. Interact Cardiovasc Thorac Surg 2013; 16: 31–36. DOI 10.1093/icvts/ivs301.CrossRefGoogle ScholarPubMed
Hager, A, Kanz, S, Kaemmerer, H, Schreiber, C, Hess, J. Coarctation Long-term Assessment (COALA): significance of arterial hypertension in a cohort of 404 patients up to 27 years after surgical repair of isolated coarctation of the aorta, even in the absence of restenosis and prosthetic material. J Thorac Cardiovasc Surg 2007; 134: 738–745. DOI 10.1016/j.jtcvs.2007.04.027.CrossRefGoogle Scholar
Ungerleider, RM, Pasquali, SK, Welke, KF, et al. Contemporary patterns of surgery and outcomes for aortic coarctation: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 2013; 145: 150–158. DOI 10.1016/j.jtcvs.2012.09.053.CrossRefGoogle Scholar
Gray, WH, Wells, WJ, Starnes, VA, Kumar, SR. Arch augmentation via median sternotomy for coarctation of aorta with proximal arch hypoplasia. Ann Thorac Surg 2018; 106: 1214–1219. DOI 10.1016/j.athoracsur.2018.04.025.10.1016/j.athoracsur.2018.04.025CrossRefGoogle ScholarPubMed
Lewis, MJ, Johansson Ramgren, J, Hallbergson, A, Liuba, P, Sjöberg, G, Malm, T. Long-term results of aortic arch reconstruction with branch pulmonary artery homograft patches. J Card Surg 2020; 35: 868–874. DOI 10.1111/jocs.14494.CrossRefGoogle ScholarPubMed
Pedersen, TA, Munk, K, Andersen, NH, et al. High long-term morbidity in repaired aortic coarctation: weak association with residual arch obstruction. Congenit Heart Dis 2011; 6: 573–582. DOI 10.1111/j.1747-0803.2011.00575.x.CrossRefGoogle ScholarPubMed
IBM Corp. IBM SPSS Statistics for Windows, Version 26.0. IBM Corp, Armonk, NY, 2019.Google Scholar
Ma, ZL, Yan, J, Li, SJ, et al. Coarctation of the aorta with aortic arch hypoplasia: midterm outcomes of aortic arch reconstruction with autologous pulmonary artery patch. Chin Med J 2017; 130: 2802–2807. DOI 10.4103/0366-6999.215279.10.4103/0366-6999.215279CrossRefGoogle ScholarPubMed
Tulzer, A, Mair, R, Kreuzer, M, Tulzer, G. Outcome of aortic arch reconstruction in infants with coarctation: importance of operative approach. J Thorac Cardiovasc Surg 2016; 152: 1506–1513.e1. DOI 10.1016/j.jtcvs.2016.08.029.CrossRefGoogle ScholarPubMed
Onalan, MA, Temur, B, Aydın, S, et al. Management of aortic arch hypoplasia in neonates and infants. J Card Surg 2021; 36: 124–133. DOI 10.1111/jocs.15212.CrossRefGoogle ScholarPubMed
Poirier, NC, Van Arsdell, GS, Brindle, M, et al. Surgical treatment of aortic arch hypoplasia in infants and children with biventricular hearts. Ann Thorac Surg 1999; 68: 2293–2297. DOI 10.1016/s0003-4975(99)01144-3.CrossRefGoogle ScholarPubMed
Bernabei, M, Margaryan, R, Arcieri, L, Bianchi, G, Pak, V, Murzi, B. Aortic arch reconstruction in newborns with an autologous pericardial patch: contemporary results. Interact Cardiovasc Thorac Surg 2013; 16: 282–285. DOI 10.1093/icvts/ivs510.CrossRefGoogle ScholarPubMed