The Frequency of Recoarctation, Depending on the Method of Reconstruction of the Aortic Arch in Newborns

Pavel V. Teplov, Alexey S. Ilin, Yuliya Y. Spichak, Konstantin A. Ilinyih, Valeriy A. Sakovich

Federal center of cardiovascular surgery, Krasnoyarsk, Russia

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – B

Abstract

Objective: compare of the methods of the aorticarch reconstructing in newborns with coarctation of the aorta.

Methods: 62 cases of aortic coarctation surgical treatment in newborns operated in 2011-2017 in which the aortic arch were reconstructed were analyzed. Surgical treatment was performed by median sternotomy, under conditions of CPB and deep hypothermia. In Group I (20 patients), aortic arch plasty along the entire length was performed using patch like a Norwood procedure. In Group II (35 patients), a semi-anastomosis was formed between the descending aorta and aortic arch, which was supplemented by a patch to expand the aortic arch. In Group III (7 patients), an extended anastomosis was performed without the use of additional materials.

Results: According to the data of the TEE in the operative room gradient of the pressure on the aortic arch was 3-20 (10 ± 3.9) mmHg, p < 0.05, when discharging from the hospital, according to TTE data, the pressure gradient on the aortic arch was 5-30 (14.0 ± 6.4) mmHg, p < 0.05. During 5 years of follow-up after surgery, recoarctation developed in group I in 6 patients (30%), in group II in 4 patients (11.4%), in group III, during the follow-up period, there was no recoarctation. Freedom from re-operations (Kaplan-Mayer) for 5 years was 74%, 90.5% and 100% for the respective groups.

Conclusion: Extended anastomosis is the most optimal method of the aorta reconstruction in newborns. However, this method is not always possible because of the extent and extreme degree of aortic hypoplasia. The formation of a semi-anastomosis with additional vascular plasty in newborn infants allows the aortic arch to be effectively expanded by modeling the correct geometry of the vessel. The latter reduces the risk ofdevelopment of recoarction in the future.