The assessment of thoracal approaches in the treatment of aortic coarctation.

Abstract

Objectives: The optimal choice of surgery in coarctation of the aorta (CoA) remains controversial but it needs to be individualised. However, in most conditions, a surgical approach through thoracotomy maintains adequate exposure to create aortic patency. This study aimed to assess the efficiency and reliability of thoracal approaches in the treatment of CoA by examining the mid- and late-term outcomes, and determining the predictive factors for re-intervention.

Methods: Patients who underwent CoA repair through thoracotomy between September 2015 and February 2023 were included in the study, except for those with complex cardiac diseases. Medical records were retrospectively analysed and peri-operative course, follow-up findings on echocardiogram and physical examinations were obtained. The complication rate, postoperative arch gradient, need for antihypertensive medication use, and freedom from re-intervention were evaluated and then compared in terms of age at surgery.

Results: Overall, 98 patients including 50 neonates were reviewed. The most common surgical method was extended end-to-end anastomosis, performed in 53 patients. The median follow-up time was 4.6 years. There was one death in hospital and one late mortality in the cohort. Eight complications were observed in the cohort but all recovered well. Overall, 13 re-interventions, six redo surgeries and seven balloon angioplasties were carried out in 12 patients. Ten of the re-interventions were carried out within the first year of the initial surgery. One- and three-year freedom from re-intervention rates were 89.5 and 86.4%, respectively. However, there was no significant predictive factor for re-intervention. Comparisons according to the age at surgery did not differ, except for intensive care unit stay. The need for hypertensive medication was initially in 14 (14.2%) patients and then reduced to eight (8%) patients. The mean peak residual gradient on postoperative examination was 9 mmHg.

Conclusion: Thoracotomy provided feasible surgical access that led to satisfactory results with a low complication rate, negligible residual gradient, low incidence of hypertension and excellent rate for freedom from re-intervention in the treatment of CoA.