Surgery for Aortic Coarctation and Hypoplastic Aortic Arch

Abstract

Objective: Overview of perioperative management and outcome of aortic coarctation, interrupted aortic arch and hypoplastic aortic arch patients. Methods: Retrospective observational analysis of data of patients presented for surgical repair of coarctation of aorta, interrupted aortic arch and hypoplastic aortic arch at Queen Alia Heart Institute (QAHI) in the period of time between 2017 and 2022. Patients’ demographic, clinical, perioperative characteristics were recorded and analyzed. Patients are also compared regarding their aortic arch diameter and (z-scores), the presence (or absence) of other associated congenital heart defects, left ventricular function, type of surgical repair, postoperative complications, recurrence of coarctation and mortality. Results: Data of 81 patients presented for surgical repair of coarctation of aorta and hypoplastic aortic arch was retrieved. Patients’ age ranged from 4 days to 21 years. Most of the patients were neonates (37%) and infants (51%). Toddlers were (6.2%), preschool (1.2%), school age (2.5%) and adult patients presented only (1.2%).  The body weight of the patients ranged from 1.8 kg to 82 kg (mean weight 6.78 kg). Most of the patients were males (64.2%). Male to female ratio was 1.8:1. The aortic arch diameter ranged from 1.8 to 16 mm with an average aortic arch diameter of 4.53 mm. The z-score of the arch diameter ranged from -9.57 to 0.12 with an average z-score of -5.123. Discreet coarctation was the most common pathology and was evident in 68 patients (84%), hypoplastic arch in 6 patients (7.4%) and Interrupted arch in 7 patients (8.6%). Most common modes of repair were with left subclavian flap (53.1%) and resection with end-to-end anastomosis (33.4%). Other less common techniques of repair were Dacron patch reconstruction (4.9%), advanced flap (2.47%), patch aortoplasty (2.47%), interposition graft (1.23%), pericardial patch (1.23%), and arch reconstruction with end to end anastomosis (1.23%). Re-coarctation (recurrence) occurred in 8 patients (9.88%). This was managed in the catheterization laboratory with balloon coarctation angioplasty (BCA) in 7 patients and one patient was surgically re-operated. Other less frequent complications were chylothorax, bilateral lower limbs weakness, global moderate left ventricular impairment, lung collapse, hypertension, left pleural collection, need for other surgery for aortic stenosis, pneumonia and seizures. Mortality occurred in 5 patients (6.17%). Conclusion: Coarctation of aorta is twice as common in males as in females. Majority of patients presenting for surgery are below one year of age. Most common surgical techniques used are left subclavian flap and resection with end-to-end anastomosis. Late recurrence occurred in less than one tenth of patients.