Surgical Treatment Of Coarctation Of The Aorta By Non-extracorporeal Circulation Pathways In Children

Objective: To evaluate the therapeutic effect of coarctation of the aorta(CoA)via a left poster lateral approach by non-extracorporeal circulation pathways in children.Methods: From February 2010 to August 2019,clinical data were analyzed retrospectively for 68 children underwent surgical repair of CoA via a left poster lateral approach by non-extracorporeal circulation pathways.There were 37 boys and 31 girls with a median age of 10.3(4.3,49.9)months and a median weight of 7.5(5.0,13.8)kilograms.Based upon operative age,they were divided into young group(? 1 year)and senile group(> 1 and < 18 years).The approaches of operation include end-to-end anastomosis,extended end-to-end anastomosis,end-to-side anastomosis,patch aortoplasty,subclavian flap aortoplasty.Perioperative medical records were analyzed and medium/long-term outcomes were followed up.Results: No patient died perioperatively.The approaches include end-to-end anastomosis(n=35,51.5%),extended end-to-end/side anastomosis(n=28,41.0%),pericardial patch aortoplasty(n=2,3.0%),Gore-Tex artificial patch aortoplasty(n=2,3.0%),and left subclavian flap aortoplasty(n=1,1.5%).The operation duration was(140.1 ± 36.3)min,the aortic cross-clamp time was(25.5 ± 8.6)min.The durations of intensive care unit(ICU)stay and ventilation were(6.2 ± 4.6)days and 15.5(6.0,28.3)hours.The postoperative length of thoracic drainage was(5.5 ± 3.9)days.The gradient of residual transcoarctation pre-discharge on Doppler echocardiography was(28.1 ± 12.0)mmHg.It was significantly lower than a preoperative transcoarctation gradient of(61.5 ± 20.0)mmHg(P<0.001).As compared to young group,operative duration,time of aortic cross-clamp and length of thoracic drainage was longer(P<0.05).However,the durations of intensive care unit(ICU)stay and ventilation were shorter(P<0.05).There was no death occurred during follow-ups and 58 patients were followed up for(50.6 ± 31.6)months.At the last time of follow-up,the transcoarctation gradient was(21.3 ± 10.1)mmHg.Two children underwent balloon dilatation because of recoarctation,the reintervention rate was 3.4%.Conclusion: Surgical treatment of aortic coarctation by non-extracorporeal circulation pathways via a left poster lateral approach is both safe and effective for children without other complicated intracardiac malformations and has ideal mid-to-long-term follow-up outcomes.