Arch Augmentation via Median Sternotomy for Coarctation of Aorta With Proximal Arch Hypoplasia

The Annals of Thoracic Surgery
W Hampton GrayS Ram Kumar

Abstract

Coarctation of the aorta can be associated with hypoplasia of the proximal transverse aortic arch. One approach to manage this condition is via left thoracotomy and extended end-to-end anastomosis with the expectation that the proximal arch will grow over time. Our preferred approach is to augment the aorta via midline sternotomy. We hypothesized that this approach is safe, durable, and allows reliable growth of the aorta. We identified the records of patients with biventricular anatomy who had coarctation of the aorta, hypoplasia of the proximal transverse arch, and no other cardiac lesion that would mandate cardiopulmonary bypass use and midline sternotomy. The records of 62 such patients operated on between 2005 and 2016 were retrospectively reviewed. Patient demographics, clinical variables and outcome data were collected and analyzed using SAS 9.4. Data are presented as median (interquartile range [IQR]). Sixty-two patients (23 girls [37%]) underwent repair at 10 (IQR, 5 to 21) days of life. Forty-nine (79%) patients were on prostaglandin infusion to maintain ductal patency. Fifteen (24%) patients presented in shock with end organ dysfunction, 17 (27%) were on inotropes, and 26 (42%) were mechanically ventilated. The proxi...Continue Reading

Citations

Jan 31, 2019·PloS One·Jordan O HamptonDavid M Forsyth
Oct 1, 2020·Journal of Cardiac Surgery·Servet ErgünSertaç Haydin
Feb 17, 2019·The Journal of Thoracic and Cardiovascular Surgery·Demetrios N Mallios, S Ram Kumar
Nov 7, 2020·The Annals of Thoracic Surgery·Shota HasegawaYoshihiro Oshima
Sep 15, 2021·The Thoracic and Cardiovascular Surgeon·Qi JiangHaibo Zhang

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