Abstract 20006: Surgical Strategy of Aortic Coarctation Repair in Early Infancy Resulting in Physiologic Arm and Leg Blood Pressures at Intermediate-Term Follow-up
Objectives: The goal of aortic coarctation repair is to produce laminar aortic blood flow resulting in a negative or absent arm:leg BP gradient. Despite satisfactory surgical results, arch hypoplasia associated with coarctation in early infancy is frequently associated with residual arch obstruction and systemic hypertension.
Methods: We use a surgical strategy to select candidates for sternotomy vs. thoracotomy in order to create an anastomosis with a diameter as large as both the adjacent proximal and distal aorta, in a tension-free setting. In all cases, we use a radically extended end to end anastomosis after aggressive aortic mobilization. Sternotomy is chosen when there is significant transverse arch hypoplasia (proximal transverse arch ≤ diameter of left carotid), the presence of a bovine arch or the presence of a co-existing intracardiac lesion requiring repair. Thoracotomy is used in all other cases. Left subclavian artery sacrifice is often necessary with either approach. Since January of 2000, all pts under 6 months of age with coarctation were repaired using this strategy. All patient data was evaluated for normal distribution, and evaluated using t-tests.
Results: From 2000-2008, 95 consecutive patients were repaired (35-sternotomy 60-thoracotomy). The median age at repair was 15±49 days. There was no in-hospital mortality. At a follow up of 50 ±23 months, mean systolic BP was 94±10 mmHg, and 84% of pts had either a negative or absent arm:leg BP gradient. Mean arm:leg BP gradient was not statistically different between groups (−8.5±15 sternotomy and −7.0 ±10 mmHg thoracotomy, p=0.7). With echo Doppler, 96% of patients demonstrated normal early diastolic reversal of blood flow in the descending thoracic aorta. Mean maximum Doppler velocity in the descending thoracic aorta was 1.9± 0.4 for sternotomy and 2.0 ±0.4 m/s for thoracotomy. Two thoracotomy patients (2.1%) required re-intervention because of abnormal arm:leg BP gradients > +20 mmHg.
Conclusions: For aortic coarctation during infancy, a strategy designed to directly address aortic arch hypoplasia results in excellent intermediate term results with both near normal aortic blood flow velocities by Doppler and arm:leg BP gradients.
- © 2010 by American Heart Association, Inc.