Abstract
Background. Extended end-to-end anastomosis (EEEA)through a left thoracotomy for coarctation of the aorta(CoA) and tubular hypoplasia of the aortic arch (THAA)leaves an unaugmented hypoplastic proximal aortic arch(PAA) segment, which may increase late reinterventionfor PAA obstruction. We sought to assess PAA growthand reintervention for PAA obstruction after EEEA.
Methods. Preoperative and follow-up echocardiographicimages of 140 patients who underwent EEEA forCoA from 2005 to 2012 were reviewed. Patients weredivided into two groups on the basis of preoperative PAAz-scores: THAA group, z-score less than L3; non-THAAgroup, z-score greater than or equal to L3.
Results. Eighty (57%) patients were identified as havingTHAA. There were three surgical reinterventions (PAA in2 patients and distal aortic arch in 1 patient) and nine catheterreinterventions (all related to anastomotic stenosis)during a median follow-up period of 18 months. Both patientswho required PAA reintervention had preoperativePAA z-scores below L8. Freedom from reintervention at 3years was comparable between the groups (THAA group,90.0% vs non-THAA group, 87.9%, p [ 0.483). Follow-upechocardiography revealed PAA catch-up growth in theTHAA group (z-score, preoperative L4.63 vs followupL1.17, p <0.001); however, there was a nonsignificanttrend toward smaller PAA in the THAA group (z-score:THAA, L1.17 vs non-THAA, L0.55, p [ 0.057). All but 2patients with preoperative PAA z-scores aboveL6 did nothave any PAA obstruction.
Conclusions. The hypoplastic PAA segment in patientswith CoA/THAA grew significantly after EEEA butremained smaller than in those without THAA. Our datasupport that CoA and PAA with z-scores as small as L6can be repaired through a thoracotomy approach with alow risk of reintervention.
| Original language | English |
|---|---|
| Pages (from-to) | 1386-1393 |
| Number of pages | 8 |
| Journal | Annals of Thoracic Surgery |
| Volume | 98 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Oct 1 2014 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Surgery
- Pulmonary and Respiratory Medicine
- Medicine(all)
Cite this
Fate of the hypoplastic proximal aortic arch in infants undergoing repair for coarctation of the aorta through a left thoracotomy. / Kotani, Yasuhiro; Anggriawan, Shirley; Chetan, Devin; Zhao, Lisa; Liyanage, Nishanthi; Saedi, Arezou; Mertens, Luc L.; Caldarone, Christopher A.; Van Arsdell, Glen S.; Honjo, Osami.
In: Annals of Thoracic Surgery, Vol. 98, No. 4, 01.10.2014, p. 1386-1393.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Fate of the hypoplastic proximal aortic arch in infants undergoing repair for coarctation of the aorta through a left thoracotomy
AU - Kotani, Yasuhiro
AU - Anggriawan, Shirley
AU - Chetan, Devin
AU - Zhao, Lisa
AU - Liyanage, Nishanthi
AU - Saedi, Arezou
AU - Mertens, Luc L.
AU - Caldarone, Christopher A.
AU - Van Arsdell, Glen S.
AU - Honjo, Osami
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Background. Extended end-to-end anastomosis (EEEA)through a left thoracotomy for coarctation of the aorta(CoA) and tubular hypoplasia of the aortic arch (THAA)leaves an unaugmented hypoplastic proximal aortic arch(PAA) segment, which may increase late reinterventionfor PAA obstruction. We sought to assess PAA growthand reintervention for PAA obstruction after EEEA.Methods. Preoperative and follow-up echocardiographicimages of 140 patients who underwent EEEA forCoA from 2005 to 2012 were reviewed. Patients weredivided into two groups on the basis of preoperative PAAz-scores: THAA group, z-score less than L3; non-THAAgroup, z-score greater than or equal to L3.Results. Eighty (57%) patients were identified as havingTHAA. There were three surgical reinterventions (PAA in2 patients and distal aortic arch in 1 patient) and nine catheterreinterventions (all related to anastomotic stenosis)during a median follow-up period of 18 months. Both patientswho required PAA reintervention had preoperativePAA z-scores below L8. Freedom from reintervention at 3years was comparable between the groups (THAA group,90.0% vs non-THAA group, 87.9%, p [ 0.483). Follow-upechocardiography revealed PAA catch-up growth in theTHAA group (z-score, preoperative L4.63 vs followupL1.17, p <0.001); however, there was a nonsignificanttrend toward smaller PAA in the THAA group (z-score:THAA, L1.17 vs non-THAA, L0.55, p [ 0.057). All but 2patients with preoperative PAA z-scores aboveL6 did nothave any PAA obstruction.Conclusions. The hypoplastic PAA segment in patientswith CoA/THAA grew significantly after EEEA butremained smaller than in those without THAA. Our datasupport that CoA and PAA with z-scores as small as L6can be repaired through a thoracotomy approach with alow risk of reintervention.
AB - Background. Extended end-to-end anastomosis (EEEA)through a left thoracotomy for coarctation of the aorta(CoA) and tubular hypoplasia of the aortic arch (THAA)leaves an unaugmented hypoplastic proximal aortic arch(PAA) segment, which may increase late reinterventionfor PAA obstruction. We sought to assess PAA growthand reintervention for PAA obstruction after EEEA.Methods. Preoperative and follow-up echocardiographicimages of 140 patients who underwent EEEA forCoA from 2005 to 2012 were reviewed. Patients weredivided into two groups on the basis of preoperative PAAz-scores: THAA group, z-score less than L3; non-THAAgroup, z-score greater than or equal to L3.Results. Eighty (57%) patients were identified as havingTHAA. There were three surgical reinterventions (PAA in2 patients and distal aortic arch in 1 patient) and nine catheterreinterventions (all related to anastomotic stenosis)during a median follow-up period of 18 months. Both patientswho required PAA reintervention had preoperativePAA z-scores below L8. Freedom from reintervention at 3years was comparable between the groups (THAA group,90.0% vs non-THAA group, 87.9%, p [ 0.483). Follow-upechocardiography revealed PAA catch-up growth in theTHAA group (z-score, preoperative L4.63 vs followupL1.17, p <0.001); however, there was a nonsignificanttrend toward smaller PAA in the THAA group (z-score:THAA, L1.17 vs non-THAA, L0.55, p [ 0.057). All but 2patients with preoperative PAA z-scores aboveL6 did nothave any PAA obstruction.Conclusions. The hypoplastic PAA segment in patientswith CoA/THAA grew significantly after EEEA butremained smaller than in those without THAA. Our datasupport that CoA and PAA with z-scores as small as L6can be repaired through a thoracotomy approach with alow risk of reintervention.
UR - http://www.scopus.com/inward/record.url?scp=84908058897&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84908058897&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2014.05.042
DO - 10.1016/j.athoracsur.2014.05.042
M3 - Article
C2 - 25152386
AN - SCOPUS:84908058897
VL - 98
SP - 1386
EP - 1393
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 4
ER -