Original articleCongenital heart surgeryAortic Arch Advancement for Aortic Coarctation and Hypoplastic Aortic Arch in Neonates and Infants
Section snippets
Study Population
The study cohort included all patients younger than 1 year who underwent an AAA for the initial treatment of CoA with HAA or concomitant treatment of CoA and associated intracardiac anomalies at Texas Children's Hospital from 1995 to 2012.
The population was divided into four groups: (1) isolated AAA (with or without atrial septal defect repair), (2) AAA with closure of ventricular septal defect (VSD), (3) other biventricular procedures, and (4) non-Norwood single-ventricle palliation.
Surgical Technique
All
Patient Characteristics
A total of 275 patients, 125 of whom were female (45%), with a median age of 14 days (interquartile range 7 to 34 days) and a weight of 3.3 ± 0.9 kg, underwent AAA during the study period (Table 1). Cardiogenic shock was the presenting feature in 43 patients (16%). Preoperative echocardiographic measurements of the proximal transverse arch were available for 233 patients (85%). The median z score for the proximal transverse arch was −5.1 (−12 to −0.31).
A total of 48 patients (17%) had
Comment
Recurrent arch obstruction is an adverse event in 2% to 31% of cases after CoA repair 3, 14, 15, 16, 17, 18, 19, 20, 21. Some of the factors that seem to be associated with a higher rate of recurrent obstruction include younger age 14, 22, 23, lower weight 24, 25, the presence of an aberrant subclavian artery [15], small aortic arch [14], and the type of surgical technique 18, 21, 26.
In a recent study by Pedersen and colleagues, 133 patients who were operated on for CoA between 1965 and 1985
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