Faculty Collaboration Database

Proximal Arch in Left Thoracotomy Repair of Neonatal and Infant Coarctation-How Small Is Too Small? World J Pediatr Congenit Heart Surg 2019 Jul;10(4):469-474

Date

07/17/2019

Pubmed ID

31307310

DOI

10.1177/2150135119852329

Scopus ID

2-s2.0-85111896149 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

BACKGROUND: We sought to evaluate the relationship between proximal arch hypoplasia and reintervention for left thoracotomy repair of coarctation of the aorta.

METHODS: This was a retrospective review of 153 consecutive neonates and infants undergoing left thoracotomy and extended end-to-end repair of coarctation from January 1, 2000, to January 1, 2014, at a single center with exclusion of single ventricle-palliated patients. Primary outcome was reintervention evaluated with respect to five definitions of proximal arch hypoplasia.

RESULTS: Median follow-up was 7.2 years. Reintervention occurred in eight (5.2%) patients, with 50% of patients undergoing re-intervention in the first six months after their index operation. Using Kaplan-Meier analysis and log-rank test, with hypoplasia defined by weight, hypoplasia was not associated with increased reintervention for arch size < patient weight (in kilograms; P = .24) or for arch size < patient weight (in kilograms) +1 (P = .02, higher freedom from reintervention in hypoplasia group). For each of the five comparison groups, freedom from reintervention was similar between the groups with and without proximal arch hypoplasia: (1) z-score < -2 versus ≥-2 (P = .72), (2) z-score < -3 versus ≥-3 (P = .95), and (3) z-score < -4 versus ≥-4 (P = .17).

CONCLUSION: In our cohort of patients with left thoracotomy and extended end-to-end repair of coarctation, proximal arch hypoplasia, defined by various weight-based or z-score thresholds, was not associated with reintervention. While this may imply value to a more liberal use of thoracotomy, confirmation requires longer term follow-up with a more comprehensive evaluation of the patients and their arches.

Author List

Callahan CP, Saudek D, Creighton S, Kuhn EM, Mitchell ME, Tweddell JS, Woods RK

Authors

Sara Elizabeth Creighton MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin
Michael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of Wisconsin
David Saudek MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Ronald K. Woods MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aorta, Thoracic
Aortic Coarctation
Body Weight
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Male
Retrospective Studies
Thoracotomy
Time Factors
Vascular Surgical Procedures