№ 5 / 2017 / 40-48

LATE OUTCOMES OF SURGICAL REPAIR OF DISTAL AORTIC ARCH HYPOPLASIA: PROSPECTIVE RANDOMIZED STUDY

Author: Soynov I.A.¹, Voytov A.V.², Kulyabin Yu.Yu.³, Omel’chenko A.Yu.⁴, Nichay N.R.⁵, Gorbatykh A.V.⁶, Zubritskiy A.V.⁷, Gorbatykh Yu.N.⁸

Author Affiliations

Abstract

Aim of the study – to compare the results of different surgical approaches through repair of the aorta coarctation with distal aortic arch hypoplasia. Material and methods. 54 patients underwent surgical treatment of the aorta coarctation took part in this pilot randomized study. Patients were divided in two groups: modified reverse subclavian flap aortoplasty (I group, 27 pts) and extended «end-to-end» anastomosis technique (II group, 27 pts). Results. In-hospital mortality was 3.7 % in each group. Recoarctation of the aorta in the late follow-up period was developed in 1 patient from group I (3.84 %) and in 2 patients from group II (7.7 %) (p = 0.5). Two patients from group I had aneurysms of the distal aortic arch (p = 0.15). Arterial hypertension was developed in 2 patients underwent modified reverse aortoplasty (7.7 %) and in 8 patients underwent extended anastomosis (30.8 %) (p = 0.03). Conclusions. Modified reverse subclavian flap aortoplasty and extended «end-to-end» anastomosis have no significant differences in morbidity and rate of early postoperative complications. Nevertheless, using of modified reverse aortoplasty allows reducing the rate of arterial hypertension development in midterm period, however there is a potential risk of development of the aneurysm of distal aortic arch, which may require further study.

Key words

coarctation of the aorta, aortic arch hypoplasia, arterial hypertension

References

Cobanoglu A., Teply J.F., Grunkemeier G.L. et al. Coarctation of the aorta in patients younger than three months: a critique of the subclavian flap operation // J. Thorac. Cardiovasc. Surg 1985. 89. 128—135.

Crepaz R., Cemin R., Romeo C. et al. Factors affecting left ventricular re-modelling and mechanics in the long term follow-up after successful repair of coarctation of the aorta // Cardiol. Young. 2005. 15. 160–167.

de Divitiis M., Pilla C., Kattenhorn M. et al. Ambulatory blood pressure, left ventricular mass, and conduit artery function late after successful repair of coarctation of the aorta // J. Am. Coll. Cardiol. 2003. 41. 2259–2265.

de Divitiis M., Pilla C., Kattenhorn M. et al. Vascular dysfunction after repair of coarctation of the aorta: impact of early surgery // Circulation. 2001. 104. 165–170.

Devereux R.B., Alonso D.R., Lutas E.M. et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings // Am. J. Cardiol. 1986. 57. 450–458.

Gargiulo G., Pace Napoleone C., Angeli E. et al. Neonatal coarctation repair using extended end-to-end anastomosis // Multimed. Man Cardiothorac. Surg. 2008. 328. ID mmcts.2007.002691.

Gorbatykh Y.N., Sinelnikov Y.S., Soynov I.A. et al. Surgical treatment of aortic arch malformations in infants under cardiopulmonary bypass // Khirurgiya = Surgery. 2015. (8). 18–21. [In Russian].

Hager A., Kanz S., Kaemmerer H. et al. Coarctation long term follow up: significance of arterial hypertension in a cohort of 404 patients up to 27 years after surgical resection of isolated coarctationevenin the absence of recordation and prosthetic material // J. Thorac. Cardiovasc. Surg. 2007. 134. 738–45.

Kaplinski M., Cohen M.S. Characterising adequacy or inadequacy of the borderline left ventricle: what tools can we use? // Cardiol. Young. 2015. 25. (8). 1482-1488.

Kaushal S., Backer C.L., Patel J.N. et al. Coarctation of the aorta: midterm outcomes of resection with extended end-to-end anastomosis // Ann. Thorac. Surg. 2009. 88. (6). 1932-1938.

Kubota H., Camilleri L., Legault B. et al. Surgical correction of the hypoplastic aortic arch by the subclavian free flap method in the neonate // J. Thorac. Cardiovasc. Surg. 1998. 116. 519–521.

Kuhn A., Baumgartner C., Horer J. et al. Impaired elastic properties of the ascending aorta persist within the first three years of neonatal coarctation repair // Pediatr. Cardiol. 2009. 30. 46–51.

Luijendijk P., Bouma B.J., Vriend J.W. et al. Usefulness of exercise-induced hypertension as predictor of chronic hypertension in adults after operative therapy for aortic isthmic coarctation in childhood // Am. J. Cardiol. 2011. 108. (3). 435-439.

Machii M., Becket A. Hypoplastic aortic arch morphology pertinent to growth after surgical correction of aortic coarctation // Ann. Thorac. Surg. 1997. 64. 516-520.

McElhinney D.B, Yang S., Hogarty A., Rychik J. et al. Recurrent arch obstruction after repair of isolated coarctation of the aorta in neonates and young infants: Is low weight a risk factor? // J. Thorac. Cardiovasc. Surg. 2001. 122. 883–890.

O'Sullivan J.J., Derrick G., Darnell R. Prevalence of hypertension in children after early repair of coarctation of the aorta: a cohort study using casual and 24 hour blood pressure measurement // Heart. 2002. 88. 163–166.

Ou P., Bonnet D., Auriacombe L. et al. Late systemic hypertension and aortic arch geometry after successful repair of coarctation of the aorta // Eur. Heart J. 2004. 25. 1853-1859.

Ou P., Celermajer D.S., Mousseaux E. et al. Vascular remodeling after "successful" repair of coarctation: impact of aortic arch geometry // J. Am. Coll. Cardiol. 2007. 49. 883-890.

Sinelnikov Y.S., Gorbatyh A.V., Ivantsov S.M. et al. Reverse subclavian flap repair and maintenance of antegrade blood flow within the left subclavian artery in neonates with aortic coarctation and distal arch hypoplasia // Heart Surg. Forum. 2013. 16. (1). 52–56.

Soynov I.A., Sinelnikov Y.S., Gorbatykh A.V. et al. Arterial hypertension in patients with repaired coarctation and hypoplastic aortic arch // Patologiya krovoobrashcheniya i kardiohirurgiya = Circulation Pathology and Cardiac Surgery. 2015. (2). 102–113. [In Russian].

Soynov I.A., Sinelnikov Y.S., Kornilov I.A. et al. Surgical correction of coarctation of the aorta with distal aortic arch hypoplasia in infants // Patologiya krovoobrashcheniya i kardiohirurgiya = Circulation Pathology and Cardiac Surgery. 2016. (2). 66–73. [In Russian].

Soynov I.A., Sinelnikov Y.S., Nichay N.R. et al. The stiffness and elasticity of the ascending and descending aorta after surgical correction of aortic coarctation // Sibirskiy nauchnyy meditsinskiy zhurnal = Siberian Scientific Medical Journal. 2016. 36. (6). 53-59. [In Russian].

Soynov I.A., Sinelnikov Y.S., Omelchenko A.Y. et al. Elastic properties of aorta after different types of surgical correction of aorta coarctation: a prospective cohort study // Arterial'naya gipertenziya = Arterial Hypertension. 2016. 22. (5). 466-475. [In Russian].

The fourth on the diagnosis and treatment of the high blood pressure in children and adolescents. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents // Pediatrics. 2004. 114. (2). 555-576.

Theodore S., Varma P.K., Neema P.K. et al. Late aneurysm formation with destruction of the left lung after subclavian flap angioplasty for coarctation of aorta // J. Thorac. Cardiovasc. Surg. 2005. 129. 468-469.

Toro-Salazar O.H., Steinberger J., Thomas W. et al. Long-term follow-up of patients after coarctation of the aorta repair // Am. J. Cardiol. 2002. 89. (5). 541-547.

Vogt M., Kühn A., Baumgartner D. et al. Impaired elastic properties of the ascending aorta in newborns before and early after successful coarctation repair: proof of a systemic vascular disease of the prestenotic arteries? // Circulation. 2005. 111. 3269-3273.

Walhout R.J., Lekkerkerker J.C., Oron G.H. et al. Comparison of polytetrafluoroethylene patch aortoplasty and end-to-end anastomosis for coarctation of the aorta // J. Thorac. Cardiovasc. Surg. 2003. 126. (2). 521-528.

Wright G.E., Nowak C.A., Goldberg C.S. et al. Extended resection and end-to-end anastomosis for aortic coarctation in infants: results of a tailored surgical approach // Ann. Thorac. Surg. 2005. 80. (4). 1453-1459.

About Authors (Correspondence):

Soynov I.A. – cardiothoracic surgeon of department of congenital cardiac surgery, researcher of center of new surgical technologies, e-mail: i_soynov@mail.ru

Full Text

snmzh_5-2017_soynov_i_dr.pdf

Received: 30/10/2017

Accepted: 30/10/2017