Fate of the hypoplastic proximal aortic arch in infants undergoing repair for coarctation of the aorta through a left thoracotomy

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.