Coarctation of the aorta with hypoplastic aortic arch :Analysis of midterm and longterm outcomes with autologous pulmonary patch aortoplasty / 医学研究生学报

ABSTRACT

Objective Previously we have reported the early and midterm benifit of autologous pulmonary patch in repairing aortic coarctation of hypoplastic aortic arch.This study aimed to assess its reliability and midterm and longterm outcomes.Methods We retrospectivly analyzed 42 pediatric patients with coarctation of the aorta (CoA) with hypoplastic aortic arch undergoing surgical repair with autologous pulmonary patch from May 2009 to May 2017 in General Hospital of Guangzhou Military Command of PLA.All the patients were allocated into either senior group (＞ 1 years) or junior group (≤1 years) according to the age of operation.The trans-coarctation gradient,pulmonary pressure and aortic Z value change were compared between two groups before and after the repair.Results There were 8 cases had early postoperative complications.However,no death had been reported during the postoperative time and the followed up period ranged from 4 months to 106 months (40.0± 15.5) months).The average pressure gradient of coarctation segment for all the patients was (11.9±6.4) mmHg,including 5 cases more than 25 mmHg.The pressure gradient and mean pulmonary arterial pressure after operation were significantly lower than those before operation (P＜0.05),The postoperative aortic arch Z value was greater than the preoperative value (P＜0.05).Compared with the preoperative period,the Z value of proximal transverse arch increased significantly(-0.64±0.44) vs (1.27±0.66),P＜0.05.Compared with junior group,the senior group had higher preoperative and postoperative pulmonary artery pressure (P＜0.05),and longer CPB time,aortic block time,ventilation time,ICU time and hospital stay time (P＜0.05).However,patients in the junior group had a higher pressure gradient through the aorta arch(P＜0.05) and a smaller Z value transverse arch aortic proximal and isthmus(P＜0.05) during the long-term period.The time of selective cerebral perfusion had no statistical difference between the two groups (P＞ 0.05).Conclusion Early surgery for coarctation of aorta with hypoplastic aortic arch,autologous pulmonary patch aortoplasty is a relatively ideal option with better midterm and longterm outcomes.