HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mohamed-Adel Elgamal E. Dean McKenzie Charles D. Fraser, Jr Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Elgamal, M.-A. Articles by Fraser, C. D. Search for Related Content PubMed PubMed Citation Articles by Elgamal, M.-A. Articles by Fraser, C. D., Jr Related Collections Congenital - acyanotic

Ann Thorac Surg 2002;73:1267-1273
© 2002 The Society of Thoracic Surgeons

---

Original article: cardiovascular

Aortic arch advancement: the optimal one-stage approach for surgical management of neonatal coarctation with arch hypoplasia

^a Congenital Heart Surgery Service, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
^b Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA

* Address reprint requests to Dr Fraser, Congenital Heart Surgery Service, Texas Children’s Hospital/Baylor College of Medicine, 6621 Fannin St, Mail Code: WT 19345-H, Houston, TX 77030-2399 USA
e-mail: charlesf{at}bcm.tmc.edu

Presented at the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.

Background. The optimal surgical treatment for neonatal coarctation with aortic arch hypoplasia (NCoAo/AAH) is controversial. Important long-term concerns include arch growth. We report our results obtained with a one-stage radical approach of coarctectomy and aortic arch advancement for NCoAo/AAH.

Methods. From June 1995 to December 2000, 65 newborns with NcoAo/AAH underwent coarctectomy and aortic arch advancement via a median sternotomy under deep hypothermic circulatory arrest. Patients were classified by diagnosis: group 1, isolated NCoAo/AAH (n = 13); group 2, NCoAo/AAH with ventricular septal defect (n = 20); and group 3, NCoAo/AAH with complex cardiac lesions (n = 32).

Results. The study population included 36 boys and 29 girls. Mean age was 13 ± 1.7 days (range 1 to 43 days). Mild to moderate left ventricular outflow tract obstruction was present in 15 patients. Mean body weight was 3.4 ± 0.1 kg (range 1.6 to 5 kg). Eight babies were premature. The mean Z value for the aortic arch was -4 ± 0.3 (range -2 to -4.5) and for the isthmus -4.5 ± 0.2 (range -3 to -7). Mean deep hypothermic circulatory arrest time was 28 ± 2 minutes (range 14 to 60 minutes). Mean intensive care unit stay was 6 ± 1 days (range 2 to 30 days). There were three early deaths (all in groups 2 and 3) and two late deaths (in group 3) (5-year actuarial survival, 91% ± 7.9%). There was one recurrence (5-year actuarial freedom from recurrence, 98% ± 4%). Peak Doppler velocity across the arch in the remaining patients was 1 ± 0.1 m/s (range 0 to 2.2 m/s).

Conclusions. Coarctectomy and aortic arch advancement is the optimal surgical method for management of NCoAo/AAH. It has low operative morbidity and mortality and a very low incidence of recoarctation or arch obstruction.

This article has been cited by other articles:

				H. L. Walters III, C. E. Ionan, R. L. Thomas, and R. E. Delius Single-stage versus 2-stage repair of coarctation of the aorta with ventricular septal defect. J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 754 - 761. [Abstract] [Full Text] [PDF]

				J.-H. Zheng, J.-F. Liu, Z.-W. Xu, Z.-K. Su, and W.-X. Ding Surgical Experience of Coarctation of the Aorta in Infants and Young Children Asian Cardiovasc Thorac Ann, December 1, 2007; 15(6): 482 - 485. [Abstract] [Full Text] [PDF]

				H.-G. Lim, W.-H. Kim, W.-S. Jang, C. Lim, J. G. Kwak, C. Lee, S. W. Hwang, and C.-H. Lee One-stage total repair of aortic arch anomaly using regional perfusion Eur. J. Cardiothorac. Surg., February 1, 2007; 31(2): 242 - 248. [Abstract] [Full Text] [PDF]

				G. E. Wright, C. A. Nowak, C. S. Goldberg, R. G. Ohye, E. L. Bove, and A. P. Rocchini Extended Resection and End-to-End Anastomosis for Aortic Coarctation in Infants: Results of a Tailored Surgical Approach Ann. Thorac. Surg., October 1, 2005; 80(4): 1453 - 1459. [Abstract] [Full Text] [PDF]

				J. A. Carr, J. J. Amato, and R. S.D. Higgins Long-Term Results of Surgical Coarctectomy in the Adolescent and Young Adult With 18-Year Follow-Up Ann. Thorac. Surg., June 1, 2005; 79(6): 1950 - 1956. [Abstract] [Full Text] [PDF]

				A. K. Fesseha, B. W. Eidem, D. J. Dibardino, S. G. Cron, E. D. McKenzie, C. D. Fraser Jr, J. F. Price, A. C. Chang, and A. R. Mott Neonates With Aortic Coarctation and Cardiogenic Shock: Presentation and Outcomes Ann. Thorac. Surg., May 1, 2005; 79(5): 1650 - 1655. [Abstract] [Full Text] [PDF]

				D. J. DiBardino, J. S. Heinle, G. C. Kung, G. T. Leonard Jr, E. D. McKenzie, J. T. Su, and C. D. Fraser Jr Anatomic reconstruction for recurrent aortic obstruction in infants and children Ann. Thorac. Surg., September 1, 2004; 78(3): 926 - 932. [Abstract] [Full Text] [PDF]