Repair of coarctation with resection and extended end-to-end anastomosis

被引:77
作者
Backer, CL
Mavroudis, C
Zias, EA
Amin, Z
Weigel, TJ
机构
[1] Childrens Mem Hosp, Div Cardiovasc Thorac Surg MC 22, Chicago, IL 60614 USA
[2] Childrens Mem Hosp, Div Cardiol, Chicago, IL 60614 USA
[3] Northwestern Univ, Sch Med, Dept Surg, Chicago, IL 60611 USA
[4] Northwestern Univ, Sch Med, Dept Pediat, Chicago, IL 60611 USA
关键词
D O I
10.1016/S0003-4975(98)00671-7
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Our surgical strategy for infant coarctation changed from subclavian nap aortoplasty to resection with extended end-to-end anastomosis in 1991. The purpose of this review was to evaluate the results of that strategy. Methods. From 1991 through 1997, 55 infants underwent repair of coarctation of the aorta using resection with extended end-to-end anastomosis. Isolated coarctation of the aorta was present in 26 patients, 20 patients had a ventricular septal defect, and 9 patients had other associated intracardiac lesions. Mean age at surgery was 0.20 +/- 0.24 years (median, 21 days). In 34 patients (62%), arch reconstruction was performed through a left thoracotomy. Twenty patients (36%) had median sternotomy with simultaneous repair of coarctation of the aorta and intracardiac repair of associated lesions. One patient had recoarctation repair through a median sternotomy. All coarctation and ductal tissue was resected and the anastomosis was constructed starting opposite the left carotid artery with running polypropylene suture. Results. There was one early death 26 days after coarctation of the aorta and ventricular septal defect repair in a child on extracorporeal membrane oxygenation for meconium aspiration and 2 late deaths owing to pneumonia and pulmonary hypertension (1) and interventricular hemorrhage (1). There were no instances of paraplegia. Follow-up in survivors ranges from 10 to 76 months (mean, 39.8 +/- 17.2 months). Recoarctation has developed in 2 patients, who have had successful balloon dilation 6 and 14 months after the operation. This yields a low recoarctation rate of 3.6%. Conclusions. Resection with extended end-to-end anastomosis yields a low mortality and particularly a low recoarctation rate and is our procedure of choice for infants with coarctation of the aorta. (Ann Thorac Surg 1998;66:1365-71) (C) 1998 by The Society of Thoracic Surgeons
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页码:1365 / 1370
页数:6
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