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The Journal of Thoracic and Cardiovascular Surgery, Vol 100, 808-816, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
F Lacour-Gayet, J Bruniaux, A Serraf, P Chambran, G Blaysat, J Losay, J Petit, J Kachaner and C Planche
From Jan. 1, 1983, to Jan. 1, 1988, 66 consecutive neonates with
coarctation and severe hypoplasia of the transverse arch underwent
coarctation repair by resection of the coarctation and reconstruction of
the aortic arch. Mean age at operation was 14 +/- 8 days, ranging from 2 to
30 days; 63% of the newborn infants were less than 2 weeks of age. The
coarctation was isolated in 23%, associated with a ventricular septal
defect in 39%, and associated with complex anomalies in 38%, including 16
cases of transposition of the great arteries or doublet- outlet right
ventricle plus ventricular septal defect, two cases of simple
transposition, two of corrected transposition plus ventricular septal
defect, and five cases of "hypoplastic" left ventricle. The surgical
technique comprises a wide resection of the coarctation extended to the
contiguous ductal tissue followed by the reconstruction of the aortic arch
in bringing the descending aorta into the concavity of the aortic arch.
This technique is able to relieve the obstruction of the aortic arch
provided that (1) the descending aorta is widely dissected to allow
mobilization and (2) the incision of the transverse arch is extended
proximal to the ostium of the left carotid artery. The operation was
performed through a left thoracotomy in 62 patients and through a
sternotomy in four additional neonates with transposition and ventricular
septal defect who underwent a one-stage repair with aortic reconstruction,
closure of the defect, and arterial switch. The overall early mortality
rate (less than 30 days) was 14% (9/66; 95% confidence limits = 5% to 22%),
including four deaths occurring within the first month, at a concomitant or
subsequent repair of the associated anomaly. There were six late deaths,
all related to the associated lesions. The overall mortality rate was 23%
(15/66; 95% confidence limits = 13% to 33%). The mean follow-up was 21 +/-
10 months, ranging from 6 to 66 months. Actuarial survival rates at 5 years
are 72% +/- 10% for the overall group; 87% +/- 17% for simple coarctation;
88% +/- 12% for coarctation and ventricular septal defect; and 52% +/- 18%
for complex coarctation. The rate of recurrent coarctation was 12.5% (95%
confidence limits = 2% to 23%), leading to five reoperations with no
deaths. Freedom from reoperation was 89.5% +/- 9% at 5 years. This
technique of coarctation repair offers several advantages: low operative
mortality, complete relief of the left ventricular obstruction, wide
resection of the ductus tissue, absence of prosthetic material, and
preservation of the left subclavian artery.
ARTICLES
Hypoplastic transverse arch and coarctation in neonates. Surgical reconstruction of the aortic arch: a study of sixty-six patients
Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Paris-Sud University, Le Plessis Robinson, France.
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