Zhang Jian,Wu Chun,Pan Zhengxia,et al.Surgical treatment of coarctation of the aorta by non-extracorporeal circulation ways:a report of 69 cases[J].Journal of Clinical Pediatric Surgery,,20():370-375.[doi:10.12260/lcxewkzz.2021.04.013]
Surgical treatment of coarctation of the aorta by non-extracorporeal circulation ways:a report of 69 cases
- CLC:
- R543.1;R726
- Abstract:
- Objective To evaluate the therapeutic efficacy of coarctation of the aorta(CoA) via a left poster lateral approach by non-extracorporeal circulation pathways in children.Methods From February 2010 to August 2019, clinical data were analyzed retrospectively for 69 children undergoing radical operations for CoA via a left poster lateral approach by non-extracorporeal circulation pathways.There were 38 boys and 31 girls with a median age of 10.4(4.4, 53.2) months and a median weight of 8.0(5.0, 14.5) kilograms.Based upon operative age, they were divided into young group(≤ 1 year) and senile group(>1 and<18 years).All operations were performed via a left poster lateral approach by non-extracorporeal circulation pathways.Preoperative and perioperative clinical data were analyzed and medium/long-term outcomes were followed up.Results No patient died perioperatively.The approaches included end-to-end anastomosis(n=36, 52%), enlarged end-to-end/side anastomosis(n=28, 41%), pericardial patch aortoplasty(n=2, 3%), Gore-Tex artificial patch aortoplasty(n=2, 3%) and left subclavian flap aortoplasty(n=1, 1%).The operative duration was(141.3±37.3) min and the aortic cross-clamp time(25.6±8.6) min.The durations of intensive care unit(ICU) stay and ventilation were(6.2±4.6) days and 16.0(6.0, 37.5) hours.The postoperative length of thoracic drainage was(5.4±3.9) days.The gradient of residual transcoarctation pre-discharge on Doppler echocardiography was(27.9±12.0) mmHg.It was significantly lower than a preoperative transcoarctation gradient of(60.9±20.5) mmHg.As compared to young group, operative duration, time of aortic cross-clamp and length of thoracic drainage was longer(P<0.05).However, the durations of ICU stay and ventilation were shorter(P<0.05).No death occurred during follow-ups and 59 patients were followed up for(49.9±31.8) months.At the last follow-up, the transcoarctation gradient was(21.4±10.0) mmHg.Two children underwent balloon dilatation and the reintervention rate was 3.4%.Conclusion Surgical treatment of aortic coarctation by non-extracorporeal circulation pathways via a left poster lateral approach is both safe and effective for children without other complicated intracardiac malformations and has ideal mid-to-long-term follow-up outcomes.
References:
1 Brown ML,Burkhart HM,Connolly HM,et al.Coarctation of the aorta:lifelong surveillance is mandatory following surgical repair[J].J Am Coll Cardiol,2013,62(11):1020-1025.DOI:10.1016/j.jacc.2013.06.016.
2 高晓音,吴春.主动脉缩窄的治疗进展[J].临床小儿外科杂志,2014,13(6):557-559.DOI:10.3969/j.issn.1671-6353.2014.06.028. Gao XY,Wu C.Recent advances in the treatment of aortic coarctation[J].J Clin Ped Sur,2014,13(6):557-559.DOI:10.3969/j.issn.1671-6353.2014.06.028.
3 Farag ES,Kluin J,de Heer F,et al.Aortic coarctation repair through left thoracotomy:Results in the modern era[J].Eur J Cardiothorac Surg,2019,55(2):331-337.DOI:10.1093/ejcts/ezy241.
4 Gropler MRF,Marino BS,Carr MR,et al.Long-term outcomes of coarctation repair through left thoracotomy[J].Ann Thorac Surg,2019,107(1):157-164.DOI:10.1016/j.athoracsur.2018.07.027.
5 李伟,刘宇航,王辉,等.新生儿主动脉缩窄的外科治疗[J].心肺血管病杂志,2015,34(2):110-112.DOI:10.3969/j.issn.1007-5062.2015.02.008. Li W,Liu YH,Wang H,et al.Surgical treatment of aortic coarctation in neonates[J].Journal of Cardiovascular and Pulmonary Diseases,2015,34(2):110-112.DOI:10.3969/j.issn.1007-5062.2015.02.008.
6 武开宏,孙剑,莫绪明,等.儿童先天性主动脉缩窄的解剖特点及外科治疗策略[J].中华解剖与临床杂志,2016,21(6):548-551.DOI:10.3760/cma.j.issn.2095-7041.2016.06.019. Wu KH,Sun J,Mo XM,et al.Anatomical features and surgical strategies of congenital coarctation of aorta in children[J].Chin J Anat Clin,2016,21(6):548-551.DOI:10.3760/cma.j.issn.2095-7041.2016.06.019.
7 Kvitting JP,Olin CL.Clarence Crafoord:A giant in cardiothoracic surgery,the first to repair aortic coarctation[J].Ann Thorac Surg,2009,87(1):342-346.DOI:10.1016/j.athoracsur.2008.08.072.
8 Früh S,Knirsch W,Dodge-Khatami A,et al.Comparison of surgical and interventional therapy of native and recurrent aortic coarctation regarding different age groups during childhood[J].Eur J Cardiothorac Surg,2011,39(6):898-904.DOI:10.1016/j.ejcts.2010.09.048.
9 Truong DT,Tani LY,Minich LL,et al.Factors associated with recoarctation after surgical repair of coarctation of the aorta by way of thoracotomy in young infants[J].Pediatr Cardiol,2014,35(1):164-170.DOI:10.1007/s00246-013-0757-6.
10 Ramachandran P,Khoury PR,Beekman RH,et al.Preoperative aortic arch size and lateoutcome after coarctation repair by lateral thoracotomy[J].Ann Thorac Surg,2018,106(2):575-580.DOI:10.1016/j.athoracsur.2018.03.084.
11 Mery CM,Guzmán-Pruneda FA,Trost JG Jr,et al.Contemporary results of aortic coarctation repair through left thoracotomy[J].Ann Thorac Surg,2015,100(3):1039-1046.DOI:10.1016/j.athoracsur.2015.04.129.
12 McElhinney DB,Yang S,Hogarty AN,et al.Recurrent arch obstruction after repair of isolated coarctation of the aorta in neonates and young infants:Is low weight a risk factor?[J].J Thorac Cardiovasc Surg,2001,122(5):883-890.DOI:10.1067/mtc.2001.116316.
13 Sakurai T,Stickley J,Stümper O,et al.Repair of isolated aortic coarctation over two decades:Impact of surgical approach and associated arch hypoplasia[J].Interact Cardiovasc Thorac Surg,2012,15(5):865-870.DOI:10.1093/icvts/ivs265.
14 Kumar DA,Nagarajan R,Sudeep V,et al.Early outcomes of modification of end to side repair of coarctation of aorta with arch hypoplasia in neonates and infants[J].Ann Pediatr Cardiol,2018,11(3):267-274.DOI:10.4103/apc.APC_5_18.
15 Torok RD,Campbell MJ,Fleming GA,et al.Coarctation of the aorta:Management from infancy to adulthood[J].World J Cardiol,2015,7(11):765-775.DOI:10.4330/wjc.v7.i11.765.
16 徐海涛,王强,李巅远,等.心包补片和肺动脉补片治疗婴幼儿主动脉缩窄合并主动脉弓发育不良疗效比较[J].中国循环杂志,2016,31(3):280-284.DOI:10.3969/j.issn.1000-3614.2016.03.018. Xu HT,Wang Q,Li DY,et al.Comparative study of autologous pericardial and pulmonary patches for treating infants with aortic coarctation plus hypoplastic aortic arch[J].Chin Circul J,2016,31(3):280-284.DOI:10.3969/j.issn.1000-3614.2016.03.018.
17 Pearl JM,Manning PB,Franklin C,et al.Risk of recoarctation should not be a deciding factor in the timing of coarctation repair[J].Am J Cardiol,2004,93(6):803-805.DOI:10.1016/j.amjcard.2003.11.064.
18 IJsselhof R,Liu H,Pigula F,et al.Rates of interventions in isolated coarctation repair in neonates versus infants:Does age matter?[J].Ann Thorac Surg,2019,107(1):180-186.DOI:10.1016/j.athoracsur.2018.07.016.
19 Vigneswaran TV,Sinha MD,Valverde I,et al.Hypertension in coarctation of the aorta:Challenges in diagnosis in children[J].Pediatr Cardiol,2017,39(5):1-10.DOI:10.1007/s00246-017-1739-x.
Memo
收稿日期:2020-01-22。
基金项目:重庆市科委面上项目（编号：cstc2020jcyj-msxm0282）
通讯作者:吴春,Email:wuchun007@sina.cn