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World J Pediatr Congenit Heart Surg. 2019 Jul;10(4):469-474. doi: 10.1177/2150135119852329.

Proximal Arch in Left Thoracotomy Repair of Neonatal and Infant Coarctation-How Small Is Too Small?

Author information

1
1 Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
2
2 Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
3
3 Department of Business Intelligence and Data Warehousing, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
4
4 Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
5
5 Department of Cardiothoracic Surgery, University of Cincinnati, Heart Institute, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA.

Abstract

BACKGROUND:

We sought to evaluate the relationship between proximal arch hypoplasia and reintervention for left thoracotomy repair of coarctation of the aorta.

METHODS:

This was a retrospective review of 153 consecutive neonates and infants undergoing left thoracotomy and extended end-to-end repair of coarctation from January 1, 2000, to January 1, 2014, at a single center with exclusion of single ventricle-palliated patients. Primary outcome was reintervention evaluated with respect to five definitions of proximal arch hypoplasia.

RESULTS:

Median follow-up was 7.2 years. Reintervention occurred in eight (5.2%) patients, with 50% of patients undergoing re-intervention in the first six months after their index operation. Using Kaplan-Meier analysis and log-rank test, with hypoplasia defined by weight, hypoplasia was not associated with increased reintervention for arch size < patient weight (in kilograms; P = .24) or for arch size < patient weight (in kilograms) +1 (P = .02, higher freedom from reintervention in hypoplasia group). For each of the five comparison groups, freedom from reintervention was similar between the groups with and without proximal arch hypoplasia: (1) z-score < -2 versus ≥-2 (P = .72), (2) z-score < -3 versus ≥-3 (P = .95), and (3) z-score < -4 versus ≥-4 (P = .17).

CONCLUSION:

In our cohort of patients with left thoracotomy and extended end-to-end repair of coarctation, proximal arch hypoplasia, defined by various weight-based or z-score thresholds, was not associated with reintervention. While this may imply value to a more liberal use of thoracotomy, confirmation requires longer term follow-up with a more comprehensive evaluation of the patients and their arches.

KEYWORDS:

arch hypoplasia; coarctation; proximal arch; reintervention

PMID:
31307310
DOI:
10.1177/2150135119852329

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