One-stage surgical treatment of 86 cases of aortic coarctation combined with intracardiac malformation / 中华胸心血管外科杂志

ABSTRACT

Objective To summarize the clinical characteristics of coarctation of the aorta( CoA) associated with intrac-ardiac anomalies in infants. Methods The data from August 2009 to August 2017 of 86 infants who were diagnosed with CoA associated with intracardiac anomalies. Preoperative diagnosis, surgical findings and post-operation follow-up were analyzed ret-rospectively. There were 56 boys an 30 girls, aqed(95. 1 ± 78. 0) days, weight(4. 6 ± 1. 2) kg. Anatomical types included 37 cases of pre-ductal CoA, 44 cases of peri-ducutal CoA, and 5 cases of post-ductal CoA. And this group also included 73 in-fants complicating VSD, 59 infants complicating ASD, 2 infants complicating DORV, and 1 infant complicating TAPVC. Re-sults All of the included patients underwent single-stage repair of CoA associated with intracardiac anomalies. Mean operative time was(279. 0 ± 56. 4) min, mean cardiopulmonary bypass time was(162. 3 ± 51. 0) min, and mean aorta cross-clamp time was(74.7 ±25.2) min. Mean length of ICU stay and ventilation time were(7.4 ±4.7) days and(101.1 ±75.4)hours, re-spectively. The residual transcoarctation gradient before discharge was lower than pre-operative transcoarctation gradient signifi-cantly[(42.3±17.7)mmHgvs.(22.1±9.4)mmHg,P<0.001],and7earlydeathswereobservedaftersurgery. The mean follow-up time of 79 hospital survivors was(31. 0 ± 27. 4) months, and no late death was found. Transcoarctation gradient of hospital survivors in the last time follow-up was(21.2 ±11.0)mmHg. Transcoarctation gradient of 29 cases was higher than 20 mmHg, however, only 4 cases with significant clinical symptom of lower limbs retardation were recommended for ballon an-gioplasty consultant. The cumulative recoarctation-free survival in 2-year follow-up was 69. 2％. Conclusion To avoid early second-stage operations, single-stage repair of CoA associated with intracardiac anomalies was effective and safe, and the out-comes of early to mid term follow-up were satisfactory.