Long-term Results of Aortic Coarctation Surgery During the 1st Year of Life

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  • Congenital Heart Surgery/Newborn Critical Congenital Cardiac. E-POSTER (ORAL) SESSION
  • E-Poster (oral)

Long-term Results of Aortic Coarctation Surgery During the 1st Year of Life

Elena Levchenko, Andrey Svobodov, Margarita Tymanyan

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – B


Methods:Retrospective analysis of the condition of 1116 patients operated on for aortic coarctation (AoCo) at 1 year of age for the period 2005-2015 in theBSCCS.AoCo repair through left thoracotomywas performed in 1023 patients (91,7%; I group): anastomosis "end-to-side" 18 (1,76%), "end-to-end" 963 (94,13%), isthmoplasty with subclavian artery 25 (2,4%), patch isthmoplasty 17 (1,67%). Balloon angioplasty (BA) was performed in 93 patients (8,3%; the II group). AoCo was combined with othercorrectionrequiring CHD in432 of patients

Results: Time of observation in catamnesis was 4.3 [2,7…7,1] years. There were no lethal outcomes not associated with surgical reinterventions. Reoperation (including staged correction of combined CHD) was performed in 301 (27%) cases. 111 children were operated recoarctation (reAoCo) (9,9%) in 182 [124…242] days after primary correction with a lethality rate of 4% (n=3): 75 children (7,3%) from the I group in 210 [150...305] days and 36 (38,7%) from the II group in 79 [8,75...156,75] days. Freedom from reAoCo to 12 years was 80%.

Risk factors of reAoCo development in group I were: age <45 days in primary surgery (odds ratio (OR) 4,5; 95% confidence interval (CI) 0,634-7,7, p=0,000), weight <3.8 kg (OR5,8; 95%CI 0,644-0,75, p=0,000), patch isthmoplasty (OR5,5; 95%CI 1,9-16,3, p=0,003); in group II: Z-score of isthmus ˂-4,1 (p=0000) and age <42 days (OR7,5; 95%CI 2,8-19,7; p=0,000).

ReAoCo formed significantly (p=0.000) more often and faster in group II. Freedom from reAoCo for group I was 87% (1 year) and 79,5% (12 years), for group II – 50% and 40%, respectively.

Conclusion: resection of the AoCo through left thoracotomy has good long-term results, excepting patch isthmoplasty. BA may be recommended as a stage I of the correction of AoCo for complicated patients with high risk of performing an open surgery.

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