Aortic arch enlargement and coarctation repair through a left thoracotomy: significance of ductal perfusion.

Details

Serval ID
serval:BIB_03F60776091F
Type
Article: article from journal or magazin.
Collection
Publications
Title
Aortic arch enlargement and coarctation repair through a left thoracotomy: significance of ductal perfusion.
Journal
European Journal of Cardio-thoracic Surgery
Author(s)
Dave H., Rosser B., Reineke K., Nguyen-Minh S., Knirsch W., Prêtre R.
ISSN
1873-734X (Electronic)
ISSN-L
1010-7940
Publication state
Published
Issued date
2012
Peer-reviewed
Oui
Volume
41
Number
4
Pages
906-912
Language
english
Abstract
OBJECTIVE: To analyse the technique of neonatal aortic arch enlargement without cardiopulmonary bypass through a left posterior thoracotomy, as an adjunct to extended resection for Coarctation and severe arch hypoplasia.
METHODS: Ten neonates with coarctation, severe arch hypoplasia and a persistent ductus arteriosus (PDA) were subjected to arch repair through a left posterior thoracotomy. Nine of these patients had associated significant intracardiac anomalies; three of them received pulmonary artery (PA) banding. After exclusion from circulation, the roof of the intervening arch between left carotid and left subclavian was enlarged using a patch. After adequate reperfusion, a classic resection and extended end-to-end anastomosis was performed. Median age and weight were 5.5 (1-10) days and 3.3 (2.2-4.1) kg respectively. The median preoperative arch diameter was 1.07 (0.75-1.32) mm/kg body weight.
RESULTS: All patients could be successfully operated with this approach. The non-ischaemic and ischaemic aortic clamp times were 40 (15-68) and 23 (18-32) min, respectively. The median postoperative arch diameter achieved was 1.43 (1.06-1.46) mm/kg body weight. None of the patients had significant gradient early postoperatively. Two patients with recurrent stenosis were successfully treated with balloon dilatation (1) or surgery with cardiopulmonary bypass (CPB) (1). One patient has a corrected gradient of 16 mmHg in the proximal arch which is being observed. The remaining patients are free from stenosis at a median follow-up of 30.1 (13.2-57.8) months.
CONCLUSIONS: Use of PDA for lower body perfusion allows complex reconstruction of the arch without incurring lower body ischaemia. The extended resection could then be performed without excessive stretch. This modification saves these patients from undergoing a complex arch reconstruction with CPB in the early neonatal period.
Pubmed
Web of science
Open Access
Yes
Create date
16/12/2014 17:35
Last modification date
20/08/2019 12:25
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