Dataset Information

Bronchus compression is a predictor for reobstruction in coarctation with hypoplastic arch repair.

ABSTRACT:

Objectives

The surgical treatment of coarctation of aorta with hypoplastic aortic arch (CoA/HAA) was challenging to achieve long-lasting arch patency. We reviewed early and late outcomes in our centre and identified predictors for arch reobstruction.

Methods

A retrospective analysis of medical records was performed to identify CoA/HAA patients who underwent primary arch reconstruction via median sternotomy between 2011 and 2020. Preoperative aortic arch geometry was analysed with cardiac computed tomographic angiography. Bedside flexible fibre-optic bronchoscopy was routinely performed after surgery in intensive care unit.

Results

There were 104 consecutive patients (median age 39.5 days) who underwent extended end-to-end anastomosis, extended end-to-side anastomosis and autograft patch augmentation. Early mortality was 3.8% and overall survival was 94.1% [95% confidence interval (CI) 89.6-98.8%] at 1, 3 and 5 years. Reobstruction-free survival was 85.1% (95% CI 78.4-92.3%) at 1 year, 80.6% (95% CI 73.1-88.9%) at 3 years and 77.4% (95% CI 69.2-86.6%) at 5 years. Preoperative aortic arch geometric parameters were not important factors for reobstruction. Nineteen patients (18.3%) were detected with left main bronchus compression (LMBC) on flexible fibre-optic bronchoscopy. Cardiopulmonary bypass time [P < 0.001, hazard ratio (95% CI): 1.02 (1.01-1.03)] and postoperative LMBC [P = 0.034, hazard ratio (95% CI): 2.99 (1.09-8.23)] were independent predictive factors on multivariable Cox regression analysis of reobstruction-free survival.

Conclusions

Aortic arch can be satisfactorily repaired by extended end-to-end anastomosis, extended end-to-side anastomosis and autograft patch augmentation via median sternotomy in CoA/HAA. Cardiopulmonary bypass time and postoperative LMBC detected by flexible fibre-optic bronchoscopy are significant predictors for long-term arch reobstruction.

SUBMITTER: Hui C

PROVIDER: S-EPMC10681811 | biostudies-literature | 2023 Nov

REPOSITORIES: biostudies-literature

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Publications

Bronchus compression is a predictor for reobstruction in coarctation with hypoplastic arch repair.

Hui Chengyi C Ren Qiushi Q Zhuang Jian J Chen Jimei J Li Xiaohua X Cui Hujun H Cen Jianzheng J Xu Gang G Wen Shusheng S

Interdisciplinary cardiovascular and thoracic surgery 20231101 5

<h4>Objectives</h4>The surgical treatment of coarctation of aorta with hypoplastic aortic arch (CoA/HAA) was challenging to achieve long-lasting arch patency. We reviewed early and late outcomes in our centre and identified predictors for arch reobstruction.<h4>Methods</h4>A retrospective analysis of medical records was performed to identify CoA/HAA patients who underwent primary arch reconstruction via median sternotomy between 2011 and 2020. Preoperative aortic arch geometry was analysed with ...[more]

PMID: 37991842

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Project description:BackgroundAortic coarctation (CoA) is a congenital heart disease that usually combines various cardiovascular malformations, including hypoplastic aortic arch (HAA). We explore end-to-side anastomosis (ESA) and autologous pulmonary artery patch (APAP) in CoA with HAA, to provide more clinical experience.MethodsThis is a single-center retrospective study. The target population is patients with aortic stenosis and HAA who underwent surgery between 2015 and 2021. All cases included were consecutive, and no instances were omitted due to absent data, lack of consent, or other factors. Collect information on gender, age, and weight at the time of the operation, detailed information on the constricted segment and pressure gradient evaluated by echocardiography and computed tomography (CT), and other factors of patients, and these data were analyzed by statistical methods.ResultsNinety-six patients (67 males and 29 females) with median age of 76 (41.75, 128.50) days and median weight of 4.20 (3.70, 5.10) kg were enrolled. The follow-up period was 46.20 (34.40, 54.70) months. The patients were divided into two groups based on surgery: ESA (G1, 59) and APAP (G2, 37). The combined cardiovascular malformations were treated simultaneously. None of the patients had neurological events or renal failure, and three died early after the operation. Finally, 93 patients were successfully followed-up. Cox regression showed that ESA was a risk factor for aortic arch geometry is closer to Gothic (G-AAg), elevated blood pressure (EBp), and aortic recoarctation (reCoA) after surgery. In G1, 18 patients had G-AAg (P=0.03), 13 had EBp (P=0.041), and 12 had reCoA (P=0.041), all of which were significantly higher than those in G2 (three had G-AAg, one of whom had EBp and reCoA).ConclusionsIt is safe and effective to repair CoA and HAA and other cardiovascular malformations through one-stage median sternotomy. Compared with ESA, APAP can lower the risks of G-AAg, EBp, and reCoA. Although APAP takes longer, the proper application of selective antegrade cerebral perfusion may lower the risks. We recommend expanding the indications for APAP when circumstances allow, which will benefit patients.

Dataset Information

Bronchus compression is a predictor for reobstruction in coarctation with hypoplastic arch repair.

Objectives

Methods

Results

Conclusions

Publications

Bronchus compression is a predictor for reobstruction in coarctation with hypoplastic arch repair.

Similar Datasets

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