The Early And Mid-term Effect Of Surgical Correction Of Aortic Coarctation With Hypoplastic Aortic Arch

Objective:Clinical data were analyzed retrospectively in 87 patients who underwent surgical correction of coarctation of the aorta(CoA)and hypoplastic aortic arch(HAA).The clinical effects of autologous pulmonary artery aortoplasty and extended end-to-end/end-to-side anastomosis were analyzed to provide a more reasonable surgical choice for clinical practice.Methods:From May 2009 to May 2017,87 patients who underwent surgical correction of coarctation of the aorta with hypoplastic aortic arch through pulmonary artery aortoplasty or extended end-to-end/end-to-side anastomosis.These patients were divided into 2 groups: Pulmonary patch group(with autologous pulmonary patch),42 atients,including 29 males and 13 females,aged from0.3 to 11.1(2.2±3.8)years.The weight of the patients ranged from 5 to 21.5(10.4±5.2)kg.According to the operative age,the patients in pulmonary patch group were divided into senile group(>1 years,n=27)and young group(?1years,n=15).Extended end-to-end group(with extended end-to-end/end-to-side anastomosis),45 patients,including 29 males and 16 females,the patients' age ranged from 0.1 to 9(1.6±2.8)years.The weight of the patients ranged from 2.5 to 18.3(8.8±5.7)kg.The patients in this group were divided into senile group(>1 years,n=25)and young group(?1 years,n=20)?All the operations were performed by the same surgeon through median sternotomy.Pulmonary artery patch group: cutting the proper size of the anterior wall of the pulmonary artery to widen the aorta.Extended end-to-end group: according to the severity of the aortic arch constriction and the lengthof the coarctation segment,the enlarged end-to-end/end-to-side anastomosis used.The changes of trans-coarctation gradient and aortic Z value at post-operation and follow-up period were compared and analyzed.The patients were followed up and analyzed using Kaplan-Meier curve.Results:1.Intraoperative and early postoperative results: one patient from extended end-to-end group died during early postoperative period.Severe complications occurred in 19 patients,8 in Pulmonary patch group,the other11 in extended end-to-end group.All the 19 cases were cured afterward by active correspondent treatments,and no neurological complication occurred in either group.2.The cardiopulmonary bypass time,aortic clamping time and ventilator time were similar between 2 groups(P>0.05).Selective cerebral perfusion time and ICU stay time in extended end-to-end group was shorter than those in Pulmonary patch group(P<0.05).The post-operative trans-coarctation gradients in Pulmonary patch group were decreased than preoperative [(9.7±3.5 mmHg)vs(36.8±12.5 mmHg),P<0.05].The Z value of transverse arch aortic and isthmus in Pulmonary patch group were increased than preoperative[(-0.50±0.21)?(-0.45±0.24)vs(-3.38±0.64)?(-2.22±0.43),P<0.05)].The post-operative trans-coarctation gradients in extended end-to-end group were decreased than preoperative(9.5±3.3 mmHg vs 37.2±8.9 mmHg,P<0.05).The Z value of transverse arch aortic and isthmus in extended end-to-end group were increased than preoperative(-0.52±0.29?-0.48±0.22 vs-3.89±0.61?-2.45±0.33,P<0.05).3.Comparison of two groups according to age: compared with young group,the senile group had a higher preoperative and postoperative pulmonary artery pressure(P < 0.05),and a longer CPB time,aortic clamping time,ventilation time,ICU time and hospital stay time(P < 0.05).4.Follow-up results:75 patients were followed up,and the follow-up time ranged from 4 to 106(32±12.8)months.No aortic aneurysm were found during the follow-up period.8 cases(10.6%)of re-stenosis(trans-coarctation gradients ?20mm Hg)were detected.In Pulmonary patch group,there were 5 patients(14.3%)with re-stenosis,2 of which underwent balloon angioplasty and the remaining 3 would be continuously followed-up.There were 8 cases(22.8%)of hypertension in thisgroup.1 case(2.8%)in younger group and the remaining 7 cases(20.0%)occurred in senior group.Extended end-to-end group had 3 patients(6.98%)with re-stenosis,2 of which underwent balloon angioplasty and 1 would be continuously followed-up.Hypertension was detected in 10 patients of extended end-to-end group,1 case(2.5%)in young group and the remaining 9 cases(22.5%)occurred in senior group.Kaplan-Meier curves presented that Extended end-to-end group was superior to Pulmonary patch group in re-stenosis occurrence,but the difference was not statistically significant.Conclusion:Coarctation of aorta with hypoplastic aortic arch should be operated as soon as possible after definitely diagnose.Both autologous pulmonary patch aortoplasty and extended end-to-end/end-to-side anastomosis were effective for these patients.The early post-operative effcacy was similar,while the mid-term follow-up result was better in extended end-to-end group.